BY AGU GRACE UCHECHUKWU PG/MSC/07/46796 M.SC … MAIN PROJECT DISSERTATI… · AGU GRACE UCHECHUKWU PG/MSC/07/46796 M.SC DISSERTATION ... (Staffing) affecting Clinical Training of

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FACTORS AFFECTING CLINICAL TRAINING OF NURSING

STUDENTS IN SELECTED NURSING EDUCATIONAL

INSTITUTIONS IN ENUGU AND EBONYI STATES OF NIGERIA

BY

AGU GRACE UCHECHUKWU

PG/MSC/07/46796

M.SC DISSERTATION

THE DEPARTMENT OF NURSING SCIENCES,

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY,

UNIVERSITY OF NIGERIA,

ENUGU CAMPUS.

JANUARY, 2014.

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FACTORS AFFECTING CLINICAL TRAINING OF NURSING

STUDENTS IN SELECTED NURSING EDUCATIONAL

INSTITUTIONS IN ENUGU AND EBONYI STATES OF NIGERIA

BY

AGU GRACE UCHECHUKWU

PG/MSC/07/46796

M.SC DISSERTATION

PRESENTED TO

THE DEPARTMENT OF NURSING SCIENCES,

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY,

UNIVERSITY OF NIGERIA, ENUGU CAMPUS,

IN PARTIAL FULFILLMENT OF THE REQUIREMENT

FOR THE AWARD OF

MASTER OF SCIENCE DEGREE

IN NURSING EDUCATION

SUPERVISOR: DR. (MRS.) ANARADO, A. N.

JANUARY, 2014.

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CERTIFICATION

This is to certify that this dissertation was originally carried out by Agu

Grace Uchechukwu in the Department of Nursing Sciences, University of

Nigeria, Enugu Campus.

___________________ ___________________

Agu Grace Uchechukwu Date PG/MSc./07/46796

_______________________ ____________________

Dr. (Mrs) A. N. Anarado Date Dissertation Supervisor

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Approval page

This dissertation, “Factors Affecting Clinical Training of Nursing Students in

selected Nursing Educational Institutions in Enugu and Ebonyi States of

Nigeria” has been approved for the award of Master of Science Degree in

Nursing Education in the Department of Nursing Sciences, Faculty of Health

Science and Technology, College of Medicine, University of Nigeria Enugu

Campus.

By

Dr. (Mrs) Anarado A. N. Date

Dissertation Supervisor

Dr. (Mrs) Uche Okolie Date

Head of Department

Prof. Obinna Onwujekwe Date

Dean FHST UNEC

External examiner Date

This day of 2013

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DEDICATION

This project is dedicated to God Almighty who protected and guided me

throughout this course of study and also to the Blessed Virgin Mary, my

Mother. It is also dedicated to all lovers of Nursing Education and Practice.

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ACKNOWLEDGEMENTS

To God Almighty who protected and carried me along throughout this

study period belongs all Glory, Honour and Kingship. This research work

could not have been a successful study without the help of many people. In this

regard, I sincerely thank Dr. (Mrs) A.N. Anarado, the dissertation supervisor

for her unalloyed and meticulous way in handling this work. Her

resourcefulness, patience and motherly advice made this final work what it is.

Many thanks go also to all the lecturers in the Department of Nursing Sciences,

UNEC for the exposure and enlightenment given to me during the course of

this study. My gratitude goes to the Catholic Bishop of Abakaliki Diocese, his

Vicar General and to our Mother General for the opportunity, care and

financial support given to me during this study. My unreserved gratitude goes

to all my Sisters and friends especially Rev. Sr. Mary Paul Odey, for

typesetting this work and also for their spiritual and moral support towards the

success of this research work.

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TABLE OF CONTENT

CONTENT PAGE

Title Page i

Certification ii

Approval Page iii

Dedication iv

Acknowledgement v

Table of Content vi

List of Tables ix

List of Figures xi

List of Appendices xii

Abstract xiii

CHAPTER ONE: INTRODUCTION

Background to the Study 1

Statement of the Problem 6

Purpose of the Study 8

Objectives of the Study 8

Research Questions 9

Hypotheses 9

Significance of the Study 10

Scope of the Study 11

Operational Definition of Terms 11

CHAPTER TWO: REVIEW OF LITERATURE

Conceptual Review 13

� Concept of Nursing Education 13

� Concept of Clinical Nursing Training 16

Objectives of Effective Clinical Nursing Education 19

CONTENT PAGE

Approaches to Clinical Skill development in Nursing Education 21

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Factors affecting Clinical Nursing Training 28

Factors associated with Students themselves 37

Constraints/Challenges of Clinical Nursing Training 42

Theory underlying the Study 46

Model of the Study 49

Empirical Studies 51

Summary of Literature Review 55

CHAPTER THREE: RESEARCH METHODS

Research Design 57

Area of Study 57

Population of Study 60

Target Population 61

Instrument for Data Collection 62

Validity of the Instrument 63

Reliability of the Instrument 63

Ethical Consideration 64

Procedure for Data Collection 64

Method of Data Analysis 65

CHAPTER FOUR: ANALYSIS AND PRESENTATION OF RESULTS

Demographic Characteristics of Students 67

Demographic Characteristics of Teachers 68

Part one, School (A) 70

Research Question 1 70



CONTENT PAGE

Part Two, School (B) 79



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Testing of Hypothesis 88

Hypothesis one 89

Hypothesis two 92

Hypothesis three 95

Summary of the Findings 97

CHAPTER FIVE: DISCUSSION OF FINDINGS

Administrative Factors that affect Clinical Training 100

Training/Supervisory Factors that affect Clinical Training 103

The Students’ Factors that affect Clinical Training 107

Hypothesis one 109

Hypothesis two 113

Hypothesis three 118

Implications for Nursing 120

Recommendations 122

Limitations of the Study 125

Suggestions for further Studies 125

Summary of the Study 126

Conclusion 127

REFERENCES 128

APPENDICES 134

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LIST OF TABLES

TABLES PAGE

Table 1: Demographic Characteristics of Students 67

Table 2: Demographic Characteristics of Teachers 68

Table 3: Respondents (School A) views of Administrative Factors

(Staffing) affecting Clinical Training of Student Nurses 70


(Staffing) continued. 72


(Infrastructure/Equipment) 73

Table 6: Respondents (School A) views of Training/Supervisory

Factors affecting Clinical Training of Nursing Students 75

Table 7: Respondents (School A) views of Students’ Factors

affecting Clinical Training of Nursing Students 77

Table 8: Respondents (School B) views of Administrative Factors

(Staffing) affecting Clinical Training of Student Nurses 79


(Staffing) continued. 81


(Infrastructure/Equipment) 82

Table 11: Respondents (School B) views of Training/Supervisory


Table 12: Respondents (School B) views of Students’ Factors


Table 13: Z- test Significance of Differences between the two

Institutions of Study with regard to the Administrative


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TABLES PAGE


Institutions of Study with regard to Training/Supervisory

Factors affecting Clinical Nursing Training 92


Institutions of Study with regard to Students’ Factors


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LIST OF FIGURES

FIGURES PAGE

Figure 1: Drefus Model of Skill Acquisition 139

Figure 2: Conceptual Model of the Study 49

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LIST OF APPENDICES

APPENDICES PAGE

Appendix 1: Target Population of Academic Staff and Students

from both Nursing Institutions of Study 134

Appendix 2 Stages of Skill Acquisition 135

Appendix 3: Questionnaire 136

Appendix 4: Calculation of Reliability of the Questionnaire 141

Appendix 5: Administrative Letter to Nursing Sciences

Department UNEC 144

Appendix 6: Letter of Identification

Appendix 7: Letter of Administrative Approval of Research work

Appendix 8: Request for number of Students and Lecturers

Appendix 9-10: Administrative Letters to School of Nursing Afikpo 148-149

Appendix 11: Application for Ethical Clearance 150

Appendix 12: Ethical Clearance Certificate

Appendix 13 &14: Informed Consents

Appendix 15: Hypothesis one 154

Appendix 16: Hypothesis two 155

Appendix 17: Hypothesis three 156

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ABSTRACT

The purpose of this study was to identify the factors that affect clinical training

of nursing students in School of Nursing Afikpo in Ebonyi State and

Department of Nursing Sciences, University of Nigeria, Enugu Campus in

Enugu State. Four research questions and three null hypotheses guided the

study. The research design used was descriptive cross-sectional survey method.

A face and content validated questionnaire with 34 items was used for the

collection of data. Data derived from the questionnaire were analyzed

descriptively and Z- test used for the hypotheses was tested at significant level

of p < 0.05. The result of the study from both schools showed that: the schools

have practical laboratories and libraries; students attend clinical experiences

regularly; ward nurses were involved in students’ clinical training, (mean

scores ≥ 3.0 which is the mean decision point). The result further showed that

in both schools there were inadequate equipment in the clinical areas; teachers

were not involved in clinical supervision of students; teachers were not able to

finish teaching their courses; non participation of students in planning of their

programme and also supervisors’ were not able to give proper supervision to

the students, (mean scores < 3.0). Findings revealed that there were significant

statistical differences (P-value < 0.05) between the two nursing institutions as

regards the administrative, training/supervisory and students’ factors affecting

clinical training of nursing students. Based on the findings, it was

recommended that adequate experienced and qualified nurse educators and

clinical instructors should be employed and maintained by the competent

authorities. Proper supervision of students by experienced teachers, nurses and

clinical supervisors should be advocated. Nursing and Midwifery Council of

Nigeria should provide a clearly written standard guidelines and policies on

clinical training of nursing students to ensure proper acquisition of nursing

skills which will be inferred in nursing practice.

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CHAPTER ONE

INTRODUCTION

Background to the study

Learning is a change in behaviour over time that is brought about by

experience during training in educational encounter (Akubuiro and Joshua,

2003). Training as part of education, is the acquisition of knowledge, skills and

competence as a result of the teaching of practical skills and knowledge that

relate to specific useful competences (Angel, 2007). Training helps the learner

to acquire certain useful skills and develop critical mind for the learner’s self

development. Therefore, the knowledge that comes from training is more of

knowledge of how to do or perform specific tasks. Thus, the modification in

behaviour as the product of training can occur following newly acquired skills,

knowledge, perception, facts, principles and new information at hand

(Adeyanju, 2004).

Nursing education is a term used to describe the overall body of

knowledge that applies to nursing profession. It encompasses a variety of

knowledge, skills, concepts, and practices which revolve around the unique

concepts of nursing, health, the person and the environment (Melone, 2010).

Nursing education consists of acquisition of a body of knowledge that is partly

delivered in a classroom setting which forms the theoretical bases of nursing

knowledge and an organized and supervised clinical training experiences that

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take place in the clinical settings where the nurse- patient relationship is

experienced directly or indirectly (Shariff and Masoumi, 2005).

Sonwuttanayut (2003) noted that the training process in nursing

education should aim at enabling the students to gain skills and experiences up

to their highest potentiality. This shall focus on the learners as being the most

important in the process. In addition, basic knowledge, attitude, skills and the

ability to apply knowledge into the actual practice of nursing should be

developed and inculcated into the student nurses in these processes. Training

can be reinforced with learning aids and equipment of different varieties

simply because they stimulate, motivate as well as arrest learners’ attention for

a while during the instructional process.

Clinical training which is part of nursing education takes place in

hospitals, other health care institutions, communities and homes under the

direction and supervision of trained personnel in nursing profession. Clinical

training as an integral part of nursing education as identified by Smith and

Fifz-Patrick, (2006), prepares student nurses with the ability of “doing” as well

as “knowing” the clinical principles in nursing practice. The clinical

experience which is a vital part of nursing education stimulates students to use

their critical thinking skills for problem solving. It provides the students

opportunity for their active self-learning, self development and ability to apply

their knowledge from theoretical context situation to emergency and general

public health care.

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In line with this therefore, clinical education must be to help the students

to acquire the necessary nursing skills and the ability to perform in order to

establish their capacity to handle changing realities and situations in nursing

practice, (Melone, 2010). The nursing skills to be acquired consist of series of

courses in the nursing curriculum and manuals. These are designed to equip

students with the required clinical nursing skills needed for optimal practice,

(Rennie, 2009). These include nurse-patient relationship skill, interactional

skills, basic physical examination skills, clinical encounter across the life span,

therapeutic communication skills, positive attitudinal skills etc. These courses

span throughout the years of studies. Students must successfully complete all

the components of the clinical courses to progress as nurses. Examining the

development of necessary nursing skills during training, Ericsson (2004)

indicates that nursing skill acquisition is a continuous learning process. This

indicates that extensive experiences and supervision from mentors, preceptors,

supervisors, teachers, considerable time on task and involvement of students

are necessary to achieve a considerable nursing skill performance. There is also

supporting evidence that the students’ interest and the practice environment

e.g. hospital, exert an influence on the development of nursing skill (Ericsson

2009). In this case, students’ goals should include increased self knowledge

and scientific awareness in addition to their gradual improvement in

professional nursing practice.

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At the beginning of the last century, nursing training was based mainly

on clinical experiences whereby students do more of clinical experiences in the

wards and receive small sums of payment (Harrison, 2010). However, with

increased complexity in today’s nursing care playing a challenge to the

theoretical and clinical training of nursing students, it was realized that

theoretical studies are of great importance in nursing education and practice.

This then led to reduction of the proportion of time spent on clinical experience

while the time and courses in relation to theoretical studies was increased

(Harrison, 2010). Furthermore, Ehiemere (2009) had highlighted that the

clinical environment is complex and rapidly changing with a variety of new

settings and roles in which nurses must be prepared to practice. Such settings

include families, schools, community settings etc. Therefore, clinical training

should be aligned to meet the challenges facing nursing practice. Although

clinical training is still an essential part of student nurses’ education, its role

and application have changed in recent years. However, in nursing education,

the classroom and clinical environment are linked and students must apply in

clinical practice what they have learned in the classroom, online and through

other exposures.

Bevis (2000) noted that teaching in clinical settings now presents nurse

educators with challenges that are different from those encountered in the

classroom, because teaching in the clinical settings require different

approaches to teaching. This increased complexity, rapidly changing and

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challenging atmosphere in nursing practice according to Harrison (2010)

requires experienced nurse teachers, clinical supervisors, infrastructure,

equipment and capable students to meet up with the challenges in nursing

practice. Where these are deficient, there is bound to be lapses and

incompetence in nursing skill acquisition which will be inferred in practice.

Few previous researches done in this area seem to confirm these assertions.

An exploratory study of the clinical learning experience of nursing

students done by Warner et al (2010) indicated that the clinical placement

duration of 6-7 weeks at a stretch for each clinical period helped the students to

study more and follow up cases in the wards, thereby influencing the level of

the overall learning and students’ satisfaction. Students were also satisfied with

the level of supervision given to them in the wards and the atmosphere in the

wards, but they reported less supervision in the clinical areas by their teachers.

Another study by Shariff and Masoum (2005) identified that students

feel anxious in their initial clinical placement; students are worried about

giving wrong information to the patients and students lack integration of theory

into clinical practice. The study also identified that staff nurses are not aware

of the skills and strategies necessary in clinical education; ward staff nurses are

not concerned about what student nurses learn during clinical experiences and

also their supervisors’ role was seen as only an evaluative one than a teaching

role.

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A study in Tanzania done by Sumari-Ayo (2006) revealed that lack of

adequate supervision of students in the clinical areas; inexperienced teachers in

the schools; unconducive environment in the school and in the clinical areas

and lack of students’ involvement in planning their programmes hinder clinical

nursing skill acquisition. However, little has been done empirically to know the

factors affecting clinical training of student nurses in the nursing institutions in

Nigeria to help find out what are involved in the training of student nurses in

the clinical areas for efficient nursing practice. This informed the researcher’s

choice of the topic, “factors affecting clinical training of nursing students in

nursing institutions” that promote or hinder their acquisition of necessary

nursing skills for adequate nursing practice.

Statement of the problem

School of Nursing, Mater Misericordiae Hospital, Afikpo, (SON-A) in

Ebonyi State as one of the institutions of study was established in 1952. It

presented first candidates for the General Nursing Certificate Examinations in

1954. The school has consistently recorded between 90% to 100% success in

the General Nursing Council Examination with many students having credits

in practical nursing examinations. This trend remained thus until 1990 when a

decline was first noted. This decline reached its climax in the 2004 November

General Nursing Council Examination when the school recorded a 20% pass

with more students failing the practical nursing examination.

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In line with this declining development, Usufu (2005) reported that the

Nursing and Midwifery Council of Nigeria (N&MCN) has observed with

dismay the general poor performance of students in the General Nursing

Council Examination especially in practical nursing examination. N&MCN

also summoned all the principals of such schools of nursing with poor result

for a conference on 20th April 2005. This was to critically review the reasons

for the poor performance in General Nursing Council Examination in order to

proffer solutions.

Also anecdotal reports from nurses in clinical arena indicated lack of

clinical skills among the graduates of the 5-year generic degree programme.

Hence between, 9th-10

th August 2011, a similar meeting of Heads of Nursing

Department with the N&MCN was held at Ibadan to discuss among other

things the BNSc graduate nurses’ poor performance in clinical practice.

N&MCN therefore, calls seriously for the adoption of a- one year internship

programme proposal for all BNSc graduate nurses before they are legible for

registration as qualified nurses to bridge their poor clinical practice

competence. This implies the inclusion of Department of Nursing Sciences,

University of Nigeria Enugu Campus (DNS-UNEC) in Enugu State as one of

the institutions of study. The two Nursing Institutions were used despite their

diversities in ownership and structure of their nursing programme because both

of them are guided by the same N&MCN Standard of Nursing Education and

Practice; also both Nursing Institutions are required to follow the same Nursing

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Curriculum to impart the necessary nursing skills to the students; they partake

in the same General Nursing Council Examinations; are registered by the same

Professional body as Qualified Nurses and are required to render the same

quality nursing care to clients. The question is, what are the factors affecting

nursing students’ clinical training that could lead to poor performance in

clinical practice?

Purpose of the study

This study investigated factors affecting clinical training of nursing

students in two selected nursing institutions, in Ebonyi and Enugu states of

Nigeria.

Objectives of the study

The objectives of the study were to:

1. Identify the administrative factors that affect clinical training of nursing

students in the school laboratories and in the clinical areas.

2. Identify the training/supervisory factors that affect clinical training of

nursing students in the school and in the clinical areas.

3. Identify students’ factors that affect their clinical training in the two

nursing institutions.

4. Determine the differences in the factors that affect clinical training of

nursing students between the two nursing institutions.

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Research questions:

As a guide to the researcher, the following research questions and hypotheses

were formulated:

1. What are the administrative factors that affect clinical training of nursing

students in the school laboratories and in clinical areas?

2. What are the training/supervisory factors that affect clinical training of

nursing students in the school and in the clinical areas?

3. What are the students’ factors that affect clinical training in the nursing

schools?

4. Are there differences in the factors that affect clinical training of nursing

students between the two nursing institutions?

Hypotheses:

Three hypotheses were tested at significant level of p< 0.05, they included:

Ho1: There is no significant statistical difference in the administrative factors

affecting clinical training of nursing students between the two schools

under study.

Ho2: There is no significant statistical difference in the training/supervisory

factors affecting clinical training of nursing students between the two

schools under study.

Ho3: There is no significant statistical difference in students’ factors affecting

clinical training of nursing students between the two schools under

study.

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Significance of the study:

Studying the factors that might affect nursing students’ acquisition of

clinical skills in nursing care while in training will assist in identifying the

constraining factors for proper acquisition of such skills. Identifying such

factors will improve students’ training in the clinical areas. Findings will

inform the school administrators and N&MCN on new approaches to improve

the system by formulating appropriate curriculum and procedures for clinical

experiences and training. This will give the right direction to the nurse

educators and supervisors and will facilitate acquisition of nursing skills by the

students. It will widen the stake holders’ view on provision of adequate

personnel like nurse educators and supervisors in the schools and clinical

areas. It will also widen the stake holders’ view on provision of equipment and

enabling environment in order to motivate students’ learning and thereby

improve institutional efforts to improve nursing practice.

The findings will help the nurse educators, clinical supervisors and

preceptors, to review how they carry out the role of clinical training of the

students under their care for better nursing skill acquisition. It will help them to

use the appropriate measures/methods in teaching the students to achieve

clinical nursing skill acquisition. The findings will help the students to

understand and play their own roles in improving their practical performance

by putting in more effort and interest in their studies and clinical practice so as

to achieve success. This will enhance their future practice as skilful and

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efficient nurses both in theory and practice. These findings could also stimulate

further study.

Scope of the study:

The study was de-limited to the students and teachers of School of

Nursing, Mater Misericordiae Hospital Afikpo in Ebonyi State and the students

and teachers in the Department of Nursing, University of Nigeria Nsukka in

Enugu State. The study addressed the institutional factors as staffing which

include teachers and supervisors, infrastructure/equipment, methods of

training/ supervising of students and students’ factors to clinical training.

Operational definition of terms

1. Clinical training: refers to how to assess clients/patients clinically, give

account of clinical health problems, prescribe and implement appropriate

nursing measures, eg through the use of thermometer to measure the

temperature of a patient and doing tepid sponging where necessary without

being told.

2. Administrative factors: refer to human and material resources needed in

proper clinical nursing training. These include provision of nurse educators and

clinical supervisors in the schools and clinical areas (e.g. nurse educators,

mentors, preceptors, clinical nurses and clinical instructors). Administrative

factors include also infrastructure/equipment in the schools and clinical

settings (e.g. adequate laboratory, library, equipment like oxygen cylinders,

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clinical thermometers, forceps, models and objects for inculcating clinical

nursing skills to nurses).

3. Training/supervisory factors: These include the techniques or measures

used to drill students during clinical training in order for them to acquire the

necessary nursing skills, e.g. through giving assignments, field trips, practical

procedures demonstration, ongoing teaching and correction of students by their

supervisors during their clinical experiences.

4. Students factors: These include students’ interest and involvement in their

training such as attendance to clinical experiences, punctuality and active

participation in assigned tasks etc.

5. Nursing educational institution: This is a hospital or university based

nursing institution accredited by the N&MCN to offer three years diploma in

nursing or five years degree in nursing sciences.

6. Student nurse: A person enrolled for the 3years diploma in General

Nursing Education programme or 5years Degree Nursing programme, in an

accredited educational institution by the N&MCN.

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CHAPTER TWO

LITERATURE REVIEW

This chapter presents related materials reviewed from books,

abstracts and articles from libraries, journals and internet materials. Discussion

is organized under the following headings;

� Conceptual review of nursing education

- Factors affecting training of clinical nursing skills

� Review of related theory

- Model of the study

� Empirical review

� Summary of literature reviewed

Concept of nursing education

Education in its broadest, general sense is the means through which the

aims and habits of a group of people live on from one generation to the next.

Generally, it occurs through any experience that has a formative effect on the

way one thinks, feels or acts, (Harrison, 2010). In its narrow, technical sense,

education is the formal process by which a profession or society deliberately

transmits its accumulated knowledge, skills, customs and values from one

generation to another, e.g., instruction in schools (Robert, 2009). Nursing

education is a term used to describe the overall body of knowledge that equips

people to practice nursing. Although nursing education encompasses a variety

of knowledge, attitude, skills, concepts and practice, the universally accepted

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concept revolves around the unique concepts of nursing, health, the person and

the environment (Melone, 2010).

Harrison (2010) affirmed that nursing education is the process of

preparing individuals for caring as nurses. Through nursing education, future

nurses learn the skills which are necessary to provide patient care, develop and

execute treatment, plan and teach clients how to take care of their medical and

other conditions. Nursing education consists of acquisition of a body of

knowledge that is partly delivered in a classroom setting which forms the

theoretical bases of nursing knowledge and an organized and supervised

clinical learning experience. This clinical training starts with practice in the

demonstration laboratory using dummies representing different areas of

nursing care. Areas where clinical training could be done include different

departments in a hospital clinics, homes, communities, psychiatric hospitals,

orthopaedic hospital, gynaecological section etc.

Nursing education takes cognizance of the national policy on education

in developing sound educational principles which are essential to the

preparation of nurses to function as members of interdisciplinary and

interdepartmental health teams (N&MCN, 2001). This programme develops

the students’ affective, cognitive and psychomotor skills in problem solving.

Active participation of nursing students in both the community and hospital

based services is essential for students sound clinical experience.

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The goal of nursing education

The goal of nursing education over the years according to Searle (2000)

has been to contribute to the health of individuals and the entire society.

Initially, nursing had concentrated on the care and comfort of all the ill and

injured but as a result of advances in health sciences, the emphasis is now

placed on promotive, preventive and rehabilitative care. Therefore, nursing

education aims at preparing competent polyvalent nurse practitioners who will

use problem solving skills in providing safe, acceptable, effective and

affordable health services to meet the health needs of individuals, families and

the community at all levels of care (N&MCN, 2001).

To achieve the aim of nursing education, there should be a systematic

direction and guidance of the students. This is to ensure that adequate nursing

knowledge is imparted to the students both theoretically and practically to

achieve proper skill and problem solving skills acquisition which will lead to

efficient nursing care (Quinn 2001).

Forms of nursing education in Nigeria:

Currently the N&MCN Standard of Nursing Education, (2010), consists of:

1. Non university based programmes such as,

(a) Basic General Nursing Certificate programme. This is done in hospital

based schools of nursing and it lasts for three (3) years.

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(b) Advanced Post Certificate Diploma. This is done in post basic schools

of nursing, e.g. school of midwifery, school of psychiatric Nursing etc

and each lasts for eighteen (18) months.

2. University based programmes

(a) Baccalaureate programme –Generic programme, consisting of

candidates coming through direct entry and those coming through

Universal Tertiary Matriculation Examination (UTME) in pursuit of

Bachelor of Nursing Science (BNSc) done for five (5) years.

UTME and Direct entry students with no professional qualifications take

N&MCN examinations and qualify as registered nurses and midwives as

part of the five year programme.

(b) Higher degree programmes –Masters Degree in Nursing Sciences (MSc

Nursing), with specialization in Maternal and Child health, Nursing

Education, Medical- Surgical Nursing, Mental Health Nursing,

Community Health Nursing and Nursing Administration and

management.

(c) Doctorate Degree in Nursing Sciences (PhD. Nursing), e.g. PhD. Nursing

Education etc.

Concept of clinical nursing training

Clinical nursing is the process through which student nurses are exposed

to real life situations in order to acquire the skills inherent in nursing

profession for effective nursing practice. It provides the students with the

necessary opportunity to acquire knowledge and skills that help in critical

31

thinking and performance of needed client’s/ patient’s care. According to

Smith et al (2006), clinical nursing training plays an important role in teaching

learning process. It provides nursing students the development and acquisition

of nursing skills, self clinical experience and the ability to apply the knowledge

gained from the theoretical context to any emergency situation or in general

public health care. It is only in the clinical situations that nursing care becomes

a reality and the student nurse can observe the responses of patients to the care

given (Melone, 2010). The overriding purpose of clinical education in nursing

is to prepare nurses to meet the health care needs of the public; therefore,

clinical nursing programme must be well aligned with the changes arising from

health care reforms, (Ehiemere, 2009).The purpose of clinical nursing is to

promote client/patients well being and help to ease suffering and discomfort in

a manner that is legal, ethical and respectful, (Melone, 2010).

The correlation of theory and practice and the building of meaningful

experiences must take place in the field of clinical practice, whether in the

school laboratory, hospital wards, clinic, or a patient’s home. The nurse learns

to interact skillfully with these people and other members of the health team.

Ehiemere (2009) affirmed that the health practice environment is becoming

complex and health care is dramatically evolving to address the quality

changes. It then demands new competencies of nursing skills and practices.

This in turn demands transformation of clinical educational programmes and

educational practices to meet up with the transformation. According to Shariff

32

et al (2005), the primary drivers of transformation in nursing clinical education

are society’s need, societal demand with increased patients’ awareness about

health and nursing practice, accountability for efficient and effective use of

education resources which include best clinical teaching practices based on

research evidence. Therefore, good clinical training based on sound nursing

education is the only option to equip nurses with the current trend in nursing

practice (Ehiemere, 2009). Mellish et al (2000) emphasizes the following

principles with regard to clinical nursing training:

• Clinical training occurs in the real-life situations: it translates theory into

practice.

• The student nurse is an active participant.

• It should be a small group activity. Physical limitations make the number of

nurses who can be involved at a stretch very small. It may even occur on

the basis of one patient, one teacher and one student.

• The student nurse is given the opportunity to develop self-confidence by

performing under expert guidance and supervision.

• It affords the student opportunities for observation and decision-making.

• It allows assessment of the degree to which educational objectives have

been attained.

• It centres on patient/client care.

33

• It is an invasion of the privacy of patients and therefore can be carried out

only with their consent except in cases where there is difficulty in doing

this. In this case patient’s relatives can be consulted.

In line with this, N&MCN stipulated that the ratio of registered nurse

educators to students in the classroom and in the clinical setting should be

1: 10, (Curriculum for General Nursing Education in Nigeria, 2001).This is for

efficient training and supervision.

The goals of clinical nursing training

The ultimate goal of clinical nursing education as indicated by Sumari-

Ayo (2006) is to prepare the students to think critically, communicate

accurately and perform indicated therapeutic nursing interventions in patient

care situations and exhibit the caring behaviours inherent in nursing actions.

They are also to apply an ethical perspective in clinical decision making and

function effectively as a team member within the organizational structures

surrounding the delivery of patient care.

Objectives of clinical nursing education

Clinical nursing education is said to be effective when the clinical

teaching and learning objectives have been achieved. According to Quinn

(2001), successful clinical teaching and learning depend on accomplishment of

the set objectives. The clinical learning objectives are:

• Provision of orientation, accessible and appropriate learning opportunities,

and adequate length of placement periods, appropriate care models, staff

34

commitment, ethics and accompaniment approaches such as preceptor

ship/mentorship system for the students to enhance learning.

• Appropriate academic staff perspectives, which involve the role of nurse

educators and their knowledge and experience, the attitude and skills which

they bring to the relationship among themselves, the student nurses and

supervisors as well as how clinical accompaniment of the students are done.

These include commitment to the relationship with placement staff,

maintenance of clinical competence, application of theory to practice,

monitoring placement evaluation, ward/unit staff development,

consideration of student nurses learning styles and the use of effective

methods for enhancing clinical learning experiences.

• Appropriate service provider/ward staff perspectives: This includes the type

of interactions that occur between the nurse educators or other

accompaniers/ward supervisors and student nurses. It involves commitment

to individualised care, a team approach, multidisciplinary teamwork,

communication with the school, commitment by service managers and

appraisal systems.

• Provision of quality assurance mechanisms. These include congruence of

curriculum and placement method, monitoring and annual review

mechanism, adequate clinical teaching and supervision of students and

maintenance of clinical practice standards and quality care (Daft 2000).

35

• Good interaction between the service provider/ward staff, educators and

students to maintain a conducive atmosphere for learning.

Approaches to clinical skill development in nursing education

Rennie (2009) asserts that while many health care institutions provide

formal nursing clinical skill training, it is difficult to determine whether it is

training or the clinical environment that informs practice. However, formal

clinical skill training limits learning only to when the resource is available

rather than what an authentic learning experience presents in the clinical area.

Clinical skill training needs to be grounded into the students with clinical

experiences and exposures to encourage incremental skill development.

Clinical skills are defined by Rennie (2009) as any action performed by

a student nurse involved in direct patient care which impacts on clinical

outcome in a measurable way. These include:

(1) Technical skills such as, taking clinical examinations and taking part in

invasive procedures during clinical experience.

(2) Non technical skills such as team working and communication.

(3) Cognitive skills such as clinical reasoning and decision making.

This implies that every action, behaviour, decision with patient/ client as

motivation is a clinical skill. Therefore, skill acquisition should be encouraged

and importantly valued more than transmission of knowledge through formal

clinical programmes. Knowles (1990) identified that the volume and

complexity of skill and knowledge of current modern technical equipment and

36

procedures is evolving at such a pace that it is no longer safe to teach students

a skill and assume the knowledge will last for their life time. Therefore, the

learning that should be encouraged in our schools of nursing should be a

lifelong learning process. This involves a process of enquiry and gathering of

information/ data rather than relying on transmission of information from

experts to learners.

In nursing education, it is traditional to prepare learners to perform in

the work place by delivering information in a classroom type environment,

and then assume that they can apply the knowledge in the clinical areas.

Superficially, this seems to be a reasonable approach. However, the shift from

modular model to this academic approach has resulted in some nurses who

qualify but are not fit for practice, (N&MC, 2005). Gallagher et al (2005)

stated that delivering information in a classroom rarely develop decision

making, attitude and retrieval. Also people have a limited attention, so

information may not be retained. However, combining this knowledge to

practical life situation helps in concretization and quick retrieval of such

information.

Patterns of clinical training in nursing education

Patterns of clinical training in nursing refer to the ways in which

programmes for clinical experiences or practical experiences are organized.

This is to meet up with integration of classroom theoretical studies with

clinical experiences which occur outside the classroom. The patterns for

37

clinical training differ from one school of nursing to another depending on the

schedule adopted by each school of nursing or each department of nursing in

the university. According to each pattern, the school, college or department of

nursing must adhere to the stipulated hours for clinical experience per session

and also for the whole course of study years according to Nursing and

Midwifery Council of Nigeria (N&MCN). N&MCN stipulated that the clinical

experience period for hospital based schools of nursing in the course of three

years programme is a minimum of 4,400 hours (Curriculum for General

Nursing Education in Nigeria 2001) which includes all the internal and

external clinical experiences. Each student must attain the number of hours for

clinical experience so as to be qualified for sitting for the profession nursing

examination.

The patterns adopted for clinical education include:

1. Training in the demonstration room

2. Block study clinical training

3. Study day’s clinical training

4. Consolidated clinical training

(1) Training in the demonstration room.

Demonstration laboratory is an apartment in the school set aside for

demonstration of procedures after the normal classroom teaching of the

theoretical bases of such procedures. It is also a place where equipment like

models, skeleton, forceps, beds, oxygen cylinders etc are kept and used to teach

38

students and also for the students to practice with first before going into the

hospital for real life practice.

Clinical training starts in the demonstration room and forms the first point

for practical experience which each school schedules to fit into their own

curriculum. It cuts across all nursing training schools as the first point of

contact between the students and the clinical instructors, teachers and

supervisors. According to Lohor (2005) clinical training in the demonstration

room takes place mainly during the early part of the training for a sufficient

period of time as is contained in the school curriculum. This is done before the

students go into the hospital wards or other places for practice. This is also

done intermittently as students are taught in the classroom.

(2) Block study type of clinical training

This pattern of clinical nursing training is one of the oldest methods of

clinical nursing training. It involves planning the yearly school programme to

indicate the specific periods when students are to go for clinical experience and

the periods they are to be in the classroom. This means that the time students

are on clinical experience areas are different from the classroom teaching

learning periods. Students are assigned to a different specific area of clinical

experience during each experience period, while classroom learning may

consist of four or six weeks at a stretch. This is mainly used in schools of

nursing.

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(3) Study day’s clinical training pattern

Studies days clinical training pattern is scheduled in such a way that

students are allowed to attend classes on certain days of the week and also go

for clinical experience some other days in the same week. It may be planned to

be three days classroom studies alternated with two days clinical experiences

or vice versa. This is also one of the oldest patterns of clinical training in

nursing

4) Consolidated clinical training pattern

This pattern of clinical training is used in the universities and can also be

used in schools of nursing. Here the clinical experience period is normally

scheduled to be at a lengthy period at a stretch, which is six months. This is

scheduled normally towards the end of the semester, so that the students may

utilize what they have learnt in the classroom to the clinical experience areas.

Any pattern of clinical training adopted by any nursing institution should

fulfill the following three requirements as adopted by Nursing and Midwifery

Council of Nigeria (N&MCN):

a. Students must complete at least 4,400 hours of clinical experiences.

b. Students must complete a defined number of clinical learning activities

as contained in their record of classroom instruction and clinical

experience schedule books.

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c. Students must have their schedule books signed by their preceptors or

supervisors, which show that they are functioning at their appropriate

level as first beginning level clinician.

Each school also develops their own procedure manuals which the

students and school teachers use to teach and demonstrate procedures

according to the school’s philosophy for care.

Actions to ensure effective clinical nursing training

The contextual elements of clinical nursing training as identified by

Iwasiw (2009) which serve as a guide to action for the clinical teachers in

nursing include the following:

1) The language of clinical teaching: The use of well worded, simple and

clear language will go a long way in helping the teacher to convey the message

to the students and also make it easier for the students to understand the topic

better.

2) Clinical training is as important as the classroom teaching. Nursing is a

professional practice discipline, where clinical training provides real life

experiences and opportunities for transfer of knowledge to practice situations.

Therefore, clinical training should be giving adequate time and concern.

3) Clinical education should reflect the nature of professional practice. A

professional is an individual who possesses expert knowledge and skill in a

specific domain, acquired through formal education in an institution of higher

learning and through experience. The professional uses that knowledge and

41

skill on behalf of the society by serving specific clients. Therefore, as practice

in clinical setting exposes students to realities of professional practice that

cannot be covered by a text book or a simulation, teaching should reflect the

nature of professional practice. Also clinical practice requires critical thinking

and problem solving abilities, specialized psychomotor and technological skills

and a professional value system.

4) The nursing students in the clinical areas are learners not qualified

nurses. The role of the student in nursing education should be primarily that of

a learner not a qualified nurse. Students should not practice without a

supervisor.

5) Sufficient learning time should be provided before performance is

evaluated. It should be known that skill acquisition is a complex process that

involves making mistakes and learning how to correct and then prevent those

mistakes in future. Therefore, clinical teachers should give adequate learning

time with ample opportunities for feedback before evaluating students’

performance summatively.

6) Clinical teaching is supported by a climate of mutual trust and respect:

Another element as a guide to action is the importance of creating and

maintaining a climate of mutual trust and respect between the staff and the

students to support learning and students growth.

7) Clinical teaching and learning should focus on essential knowledge,

skills and attitude. Teaching and learning time should be used to maximum

42

advantage by focusing most of the time and effort on the most common

practice problems that students and staff members are likely to face.

8) The espoused curriculum may not be the curriculum in- use. Argyris

and Schon (1994) proposed that human behaviour is guided by operational

theories of action that operate at two levels. The first level, espoused theory

(the paper curriculum) is what individuals say that they believe and do. The

other level, theory in use (the practice theory curriculum) guides what

individuals actually do in spontaneous behaviour with others. Similarly, the

espoused curriculum is the one that is used for accreditations or state approval

but the curriculum in-use is what actually happens. This disparity happens

often when clinical teachers do what seem right to them which are not in the

curriculum. Incongruity between espoused theory and theory in use can result

in ineffective individual practice as well as discord within a school system.

Factors affecting clinical nursing training

The major determinants of the effectiveness of clinical training are the

context in which they occur. According to Smedley and Penney (2010),

clinical training in nursing is performed in response to the professional,

societal and educational demands using available human intelligence, physical

and financial resources as the context of the curriculum. As far as the

curriculum context is different for each nursing program, so also the practice of

clinical training should differ from one nursing programme to another. This

infers that there should be differences in the factors that affect clinical training

43

of nursing students. This implies that some of the factors that could affect

clinical training in nursing include the curriculum philosophy, the context for

clinical nursing training and resources needed for effective clinical training in

nursing. Therefore each school must make decisions that are congruent with

their planned curriculum for a successful acquisition of skill. The factors are:

1) The curriculum philosophy: The curriculum is a systematic plan of

activities which is made according to each school philosophy and mission in

response to the professional, societal and educational needs. This includes

statement of belief about the goals of nursing education, the nature of teaching

and learning and the role of the teachers and learners (Iwasiw, Goldenberg,

Andrusyszyn, 2009). The values and beliefs included in a curriculum

philosophy provide structure and coherence for a curriculum and provide clear

actions to be followed. Statements of curriculum are meaningless if they are

contradicted by actual nursing educational practices. Although traditionally,

philosophy is viewed as essential tool in building a curriculum, some nursing

education leaders have suggested that a set of assumptions or one or more

theories could be used in planning the nursing curriculum, (Bevis, 2000).

When used as a curriculum foundation, learning theories such as behaviorism,

cognitive theories etc, reflect faculty belief about learning, teaching, student

characteristics and the educational environment. Iwasiw et al (2009) indicated

that nursing theories such as Rogers’ unitary person model, Newman’s model

of health and Watson’s theory of human caring may also serve as both

44

theoretically and philosophically according to the context of each curriculum.

Therefore, the contemporary nursing curriculum philosophies often are a blend

of philosophy, nursing theory and learning theory. The curriculum provides a

framework that shows educational and clinical activities to be followed in

clinical training. Incongruity between the curriculum and the actual activities

of the school can result in ineffective individual learning/practice as well as

discord within a school system.

2) The context for clinical nursing training: This includes the medium or the

actual practical application of the training process. Those are the measures or

actions involved in the clinical training. Oermann and Gaberson (2009)

asserted that every clinical teacher has a philosophical approach to clinical

training whether or not the teacher realizes it. The context determines what the

teacher understands as his role, approaches to clinical training, selection of

teaching and learning activities, use of evaluation process and relationship with

learners and others in the environment. It includes also how the students play

their own roles in the teaching learning process. These beliefs serve as a guide

to action and they affect how clinical teachers practice, how students learn and

how learning outcome are evaluated. Inadequacy in the context jeopardizes the

acquisition of required nursing skills.

3) Resources needed for effective clinical training in nursing.

For efficient and effective clinical training aimed at ensuring quality

care, theoretical nursing taught in the classroom must be repeated and in

45

congruence with what the students practice in the clinical areas (Oermann and

Gaberson, 2009). To maintain this fact, there must be competent personnel in

the schools and the wards to supervise and handle the clinical aspect of nursing

effectively. The resources needed are:

A) Qualified and experienced nurses:

There should be qualified and experienced nurses and clinicians,

mentors, preceptors, link teachers and teacher- lecturers in the schools and

hospitals or other places where the students go for their clinical training. These

nurses must be conversant with the new innovations in nursing research,

education and practice, so that they may be able to help the students under their

care. These human resources employed in clinical training of students help the

students to enhance the practical learning process and ensure production of

qualitative, critical thinking and benevolent nurses who will engage in decision

making and evidence based nursing care based on research findings.

B) Nurse educators and supervisors:

These are professional nurses acting as teachers, mentors, preceptors,

clinical instructors and clinicians involved in planning, facilitating and

supervising of clinical training of nurses to ensure adequate nursing skill

acquisition.

It is a well known fact that teachers and supervisors are crucial factors in

students’ school achievement. Some nurse educators and researchers like

Usufu (2005), Shariff and Masoumi (2005) seem emphatic that students’

46

academic performance does to a large extent depend on the quality, adequacy

and dedication of teachers and their supervisors. It is also identified that

expensive laboratories, nursing equipment, costly reference libraries, superior

text books, extensive clinical experience areas and skillfully arranged courses

of study are of little value in the teaching of nursing science subjects unless

they are presided over and administered by the mind of an individual who

knows and loves nursing profession and who has acquired some nursing skills

and the art of impacting this knowledge to others, (Hopkins, 1994). This

clearly shows that the role of qualified and experienced teachers and

supervisors in the teaching and learning of any skill or subject cannot be

underestimated. Commenting on the need and use of professionally trained

teachers and supervisors, Akambi (1998), said that they will ensure efficiency

and make sure that they impart the right knowledge, develop the needed skills

and mental faculty of the students they are teaching. He further stated that a

professionally prepared teacher can use even an inadequately structured

curriculum to build a structured programme of significant merit. Lohor (2005),

cries out that in the many states of the country, 40% and 50% of nurse

educators and clinical supervisors needed are lacking. One resultant effect in

this respect is that few available ones are faced with the problems of coping

with a large class of students for the classroom work and clinical training. In a

paper presented to the principals of schools of Nursing in Nigeria, Usufu

(2005) stated in line with the teachers’ factors that to some extent, the teacher

47

judges his/her performance from the performance of the students. Where the

students perform poorly both the students and the teachers should have cause

to give serious consideration about their teaching and learning.

C) Infrastructure/equipment in the schools and clinical settings

Items or equipment used in the schools and clinical areas are regarded as

the life wire of any nursing school and for there to be a meaningful nursing

education, (Melone, 2010). There must be that conscious effort to direct

sufficient resources to such areas that will ensure drawing maximum benefit

from the equipment and infrastructure available.

For standard nursing education, lack of equipment sets back students’

performance and creates a lot of tension and anxiety on the students because of

poor performance. Cannon (1997) emphasized strongly the unavoidable needs

for adequate equipment, noting that, “at all stages of skill acquisition, good

demonstration with adequate equipment is important and often a vital part of

teaching in acquiring a skill we learn by imitation”. Accordingly, Tonne (1999)

observed that the most effective device for the teaching of skill is teacher

demonstration with appropriate equipment. For example, a teacher who shows

to students how to type using a computer saves time and presents these

students with useful tips more than he can give by merely talking. It is

therefore, a right deduction that no nursing school can function well without

proper and adequate equipment in the school and in the clinical areas. The

schools should have adequate and up to date text books in the library which

48

will serve as reference materials for both the teachers and the students.

Knowles (1990) and the WHO (1999) indicated that appropriate clinical

learning facilities such as laboratory, library, equipment and supplies should

always be made available and maintained regularly to make learning concrete

and easier to reproduce when needed.

D) Measures /designs for teaching clinical nursing skills include:

(i) Preparation and Planning

Planning for clinical accompaniment of students is a prior activity which

should be done by involving all key players. Gerrish (1992) (in Quinn 2001)

maintains that teaching in practice placement areas requires a commitment by

the teachers, collaboration between education and service staff and staff

development for teachers in their new role in relation to practice. The

accompanists and the student nurses should participate in planning and

preparation for clinical accompaniment. The key features of effective clinical

education are that it is designed and conducted according to the learner’s

characteristics and the use of appropriate teaching and learning strategies.

Several factors need to be considered when drawing up a plan.

According to (Quinn, 2001), the curriculum has an influence on clinical

nursing education by accommodating the essential principles and features for

an educational proposal in such a form that it is capable of effective translation

into practice. Therefore, the planning team should consider what has been

described in the curriculum in fulfilling clinical teaching and learning. The

49

planning team includes nurse educators, clinical instructors, preceptors, ward

supervisors and nursing students.

The clinical training objectives should be taken into account when

practicing. Chun-Heung and French (1997) cautioned about students spending

most of their time doing routine work and menial tasks thus wasting time for

clinical learning. Nursing educators, preceptors and other clinical supervisors

should select and agree on appropriate methods and materials, ensuring that

they are available and relevant to learning outcomes. Planning should be

systematic and realistic to ensure that students know what is expected of them

and when. The plan should allow for flexibility in order to meet unforeseen

eventualities. Quinn (2001) suggests that in order to select strategies that

enable deep holistic learning to take place, nurse educators and supervisors

should be aware of students’ differences, ways that keep students motivated

and interested.

Daft (2000) stresses the value of maintaining a good working

relationship with ward personnel, expertise like medical and paramedical in a

formal clinical education programme, so that they can be consulted when there

is a need.

Division of the time available and allocation of personnel so that all

students have an equal opportunity to benefit is essential (Quinn, 2001).

Specific times should be set aside when students are released from the wards

for formal activities, such as demonstrations of procedures.

50

(ii)Techniques/ measures used for effective clinical training in nursing

One of the most important responsibilities of a clinical teacher is

selecting and giving clinical assignments that are related to desired outcome to

students. This should be appropriate to students’ levels of knowledge and skill

and challenging enough to motivate learning. Directing a learner to provide

comprehensive nursing care to one or more patients is a typical possible

clinical assignment and not always the most appropriate choice.

The techniques include:

• Giving assignment to students and correcting them

• Ongoing assessment in the clinical areas for early detection of lapses

• Proper supervision and prompt correction.

• Mentoring as students learn by imitation

• Motivation of students by encouraging their little efforts

• Evaluation to elicit learning outcome

Evaluation techniques in clinical training

Evaluation is the process of eliciting the extent to which learners have

achieved the educational objectives. It is used also for assessment of both the

teacher and the students and its outcome helps both the teacher and the

students to know areas of their deficiencies and areas of strength. Evaluation

can be formative or summative. Some of the evaluation strategies in clinical

51

nursing training according to Oermann et al (2009) include written and oral

assignments.

i) Written assignment: Written assignments should build on one another to

progressively develop student’s skills. It should be used to promote

understanding, develop higher level thinking skills, examine feelings, beliefs

and value, develop writing skills, etc.

Examples of written assignments are:

• Use of case method and case study

• Evidence- based practice papers

• Development of teaching plan and nursing care plan

• Writing journals

• Giving tests and examinations

ii) Oral practice assessment (practicum) or clinical evaluation. This means

testing the students’ ability to do the activities which they learnt during the

clinical training. It can be done formatively or summatively as is scheduled in

the school’s programme following the procedure and the schedule books.

Factors associated with students

In a study done by Baillie (1993) on the importance of showing an

interest and taking initiative by students, student nurses recognized that their

own approach to placements areas affected their learning. They also found that

students prefer active participation to observation. Furthermore, they suggested

that good mentor, communication and organizational environment were good

52

for learning. According to Sims (1997) students get satisfaction in doing things

that interest them which promote better learning. Consequently, better learning

gives higher satisfaction and this cycle continues.

In a study by German (1994), it was observed that students’ attitude

towards school subjects can directly or indirectly influence their performance

in those subjects. Those that have positive attitude towards Biology were

expected to be interested in doing Biology and science like activities. This was

proved to be true from using path analytic model. He hypothesized that attitude

towards Biology in schools would influence students’ performance in biology

because the students would dread the subject they dislike.

Students’ performance in nursing clinical experiences depends on

whether the student likes nursing science subjects’ classes, feels that nursing

science will be useful and is not afraid to ask questions during clinical

experiences (Meloni, 2010). Osang (1990) tried to find out the relationship

between students’ self concept and performance and noted that students’

performance in nursing clinical training depended much on what the student

thought of or believed about him or herself with reference to nursing science.

This result shows that self concept is positively related to achievements by

students. Gardnerr & Supplee (2010), noted in their study that interest is a key

factor for effective teaching and learning. It has been recognized that where

interest is manifested adequately, the inhibiting influence of the limited

background and ability of the student is reduced to manageable proportions.

53

It is then important to help students establish and develop scientific spirit

and experimental attitude needed in nursing to enhance practice, (Ricks, 1999).

Ricks (1999) stated also that effective nursing science programme makes room

for students to discover solutions to problems themselves and not make them

mere speculators.

Other things that influence students’ attitude and performance are

students’ home environment, background knowledge of the subject and

motivation by the teachers and peers. In planning clinical activities for the

students, their learning styles should be considered to help them participate and

learn better, (Billings and Halstead, 2005).

Student nurses’ learning styles

The level of independent learning depends much on the course planners

who identify what and how it should be learned with the availability of

required resources. During clinical experiences, student nurses get a chance to

utilize their preferred learning styles to achieve the clinical learning objectives.

Billings and Halstead (2005) emphasized the need for teachers to utilize the

different learning cognitive styles in ward-based practice to ensure effective

clinical learning. According to Bastable (2003) and Hinchliff (2005), students

perceive and process information using different learning styles. These

learning styles are biologically or sociologically acquired by the students. It

holds that the teachers and supervisors should use the styles in handling the

students. Bastable (2003) identified four learning styles used by students,

54

namely diverger, assimilator, converger and accommodator, based on Piaget’s

and Guilford’s theories of thinking, creativity and intellect. These learning

styles are briefly discussed below.

• Accommodators are active in experimentation (busy “doing”) and engage

in concrete experience (“feelings”). Such learners are good at carrying out

plans and getting things done. They are people-oriented, see and exploit

opportunities and are committed to meeting objectives. They rely on other

people for information rather than use their own analytical ability. They are

more inpatient and bold than other types. According to Killen (2000), they

benefit from teaching strategies such as problem-solving and ward

placement. Writing reports of case studies can be stimulating to such

students during clinical experiences.

• Convergers learn better by active conceptualisation (theorists) (“thinking”)

and active experimentation (“doing”). They are good at problem-solving,

making decisions, setting goals and selecting the best solutions. Killen

(2000) describe them as being less oriented to people. The teaching

strategies that benefit convergers include problem solving, demonstration

and ward placement.

• Divergers (reflectors) are good at learning through concrete experiences

and reflective observation (“watching”). According to Killen (2000),

teaching strategies such as group discussion and brainstorming are

beneficial to student nurses with this type of learning style.

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• Assimilators (pragmatists) learn through active conceptualisation,

reflective observation, theory building and inductive reasoning. They are

also good at designing experiments, analysing quantitative data and

organising information. They benefit from teaching strategies like formal

lectures, writing papers, and seminars.

The different learning styles show that students benefit from teaching

strategies such as ward placement, problem solving, role-play, small group

discussion, audio-visual simulation, and demonstrations in which they have

personal encounters. Billings and Halstead (2005) emphasized that student

nurses should be guided to learn and to perform practical skills in

demonstration laboratory before they encounter real patients. According to

Hallet (1997), student nurses should be accompanied during clinical learning

so that opportunities are provided for them to gain experience, permitting them

to progress gradually from dependency to independency.

Facilitating student learning in clinical practice:

Within the changing health climate, clinical training has become a large

part of the nurse's role, including the facilitation of student learning. Yet there

is still a lack of clarity with regard to the person that should be responsible for

the clinical teaching of students on a daily basis and what the role entails

(Waldock, 2010). From an international perspective, Pellatt (2006) noted that

supervision of students in the clinical areas appears to have been left to the

clinical nurses who are always with the students. This has created a degree of

56

discomfort for many students and nurses, as students believe they lack the

preparation and/or experience in student supervision, particularly through

clinical teaching. Given this situation, it is not surprising that the quality of

student supervision and role satisfaction for both nurses and students cannot be

assured through current practices.

According to Waldock (2010) registered nurses (RNs) working with

student nurses in the clinical setting have a major influence on student

performance as they are more with the students than their other supervisors.

They have the ability to promote and facilitate student learning or cripple the

students' ability to apply knowledge and skills and accommodate new learning

in clinical practice. Some of the identified factors that affect student nurses in

clinical practice include: support provided by the education faculty and health

provider, preparing the nurses for the supervision role, time and workload

allocation and the nurse/student relationship. The quality of clinical placements

as perceived by students in terms of support, clinical teaching and learning,

and the integration of theory into practice vary considerably from one

experience to the next. Harrison (2010) advocated for an on-going training,

seminars and conferences for these nurses in the clinical areas. This is to

update and equip them with the current nursing skills.

Constraints/ challenges of clinical training in nursing:

Although a lot of positive changes have occurred in modern clinical

nursing training as indicated by Baker (2000) such as improvement in the

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pattern of clinical training, some factors still act as constraints to the effective

clinical training in nursing. Some of the constraints noted by Searle (2000)

are:

• Lack of clearly written standard guidelines and policies on clinical training

of student nurses.

• Lack of time on the part of nurse educators or the supervising persons due

to workload or other commitments.

• Personnel who are concerned with clinical supervision not interested in

clinical teaching and learning.

• Inappropriate curriculum and reference materials for teachers and students.

Others include:

(1) Lack of theory- practice integration: The gap between theory and

practice in nursing has posed a lot of confusion to the student nurses, in that

what they learnt in the classroom is different from what is obtainable in the

clinical areas. Wallin, Wikblad and Ewald (2003) indicated that research has

shown also that one of the contributing factors to lack of theory practice

integration is the sequence in which the theory is taught and implemented. The

gap created may be due to certain factors such as lack of experience and

knowledgeable teachers to supervise and teach the students in the clinical

areas, limited procedures in the hospitals for students to practice what they

learnt in the classroom and also inexperienced nurses working in the hospitals

who are not updated with the current trends in nursing practice.

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(2) Inadequate trained and experienced nurses. Lohor (2005) emphasized

that inadequate number of trained and experienced nurses jeopardize the

process of nursing education both in the classroom and in the clinical settings

especially in the clinical areas. This makes it difficult for students to be guided

well in the clinical areas where the ratio of students per a practical teacher will

be very large for the teacher to handle. Also, inadequate number of preceptors

and supervisors in the clinical areas posed a lot of constraints. Nursing

curriculum stipulates a ratio of 1:10 as the adequate teacher/student ratio for

clinical training, (N&MCN General Nursing Curriculum 2001).

(3) Lack or inadequate funding: Funding goes a long way to help in

clinical training of nurses. Lack of fund affects every other aspect in the

training such as adequate staffing, students’ motivation, provision of

equipment etc. Therefore, lack of fund for the provision of the materials

necessary for clinical training will jeopardize the training.

(4) Inadequate length of time for clinical practice: The time allocated for

clinical practice goes a long way in promoting practical learning skills. The

length of time for clinical experience helps to determine how well they may

learn the skills. Inadequate length of time does not help the students to learn

much before leaving the clinical area.

(5) Lack of patients or client to practice with: Nursing profession is a

practice dominated service profession. Therefore, it requires that the student

nurses need to do a lot of practice under guidance to enable them to learn the

59

art of nursing. Lack of patients does not provide opportunities for real life

practice.

(6) Lack of equipment: Clinical nursing training need varieties of

equipment such as models, beds, oxygen cylinders, machines of different

types, etc to practice with to gain knowledge and mastery. In recent time, with

the technological boom, more sophisticated equipment should be needed also

to meet up with the current global trend in nursing.

(7) Inadequate supervision: This is as a sequence of lack of enough

supervisors, preceptors and clinical teachers who are supposed to guide, teach,

supervise and assess the students in their clinical areas. Inadequate supervision

leads to lack of students’ assessment and evaluation to elicit the extent of

knowledge and practice gained by the students.

(8) Limited procedures for nurses: Nurses have limited procedures to

practice with in the clinical arena compare to the procedures they learnt in the

classroom, for example, giving an intravenous line medication. This does not

give room for them to practice all the procedures learnt in the classroom

thereby leading to poor performance in those aspects of nursing practice, e.g.

some training hospitals do not allow nurses to carry out procedures like

intravenous medications etc.

(9) Lack of collaboration between the nurses in the hospital and

teachers in the classroom. It is said that training of students should include

mutual understanding and trust between the teachers in the school, the

60

supervisors in the clinical areas and the students to motivate both parties to

action. Where this is lacking, it brings ill feelings and lack of interest on the

students and the nurses who teach and supervise them.

(10) Selection of wrong candidates for training: Wrongly selected

candidates for nursing training pose a lot of problems in the clinical training

because the students may lack interest in the studies and practice. These

candidates can be “untrainable” students who lack interest in nursing

profession but want to be nurses because of other interests such as economic or

interest in traveling oversea (Lohor, 2005). This makes teaching and learning

very tedious for both the teachers and the students because they lack the ability

and interest to study nursing.

(11) Lack of incentive to teachers and supervisors: Lack of incentives to

the teacher, supervisors and nurses in the clinical areas affect clinical training

of students and pose a lot of constraints to clinical training. These incentives

include opportunities for attending workshops, conferences and seminars etc

especially in research and new technological approaches in nursing which are

widely in use today.

Theory underlying the study:

Theory underlying factors that affect clinical training of nursing students

in nursing schools is the Dreyfus model of skill acquisition as developed by

Benner (2004). This model contains a systematically planned process for

teaching students to acquire the required clinical skills for nursing practices.

61

The Dreyfus model of skill acquisition is a model of how students acquire

nursing skills through formal instruction and practical experiences. It has

originally five steps such as novice stage, advanced beginner, competent stage,

proficiency stage and expert stage.

(1) Novices’ stage: This being the first step, orientations and instructions on

the subject matter are given to the students. Rigid adherence to taught rules,

plans of actions, procedures of doing things are advocated by the trainer. The

students have no sense of responsibility beyond following the rules and

procedures exactly. In this stage, good orientation and practical demonstrations

of nursing skills by a professional is advocated.

(2)Advanced beginners: With the teacher’s drilling of instructions,

demonstrating and students practicing procedures with adequate equipment

and adequate supervision of students, students leave the former stage. Here

individual students develop organizing principles to quickly access the

particular rules or procedures that are relevant to the specific task at hand.

Students also have limited situational perception and treat all aspect of work

separately with equal importance. Students’ participation in practicing the

things they have been taught help them to understand the nursing skills

involved well.

(3) Competent stage: With much exposure and practice, training becomes

more concrete. Students now are engaged in active decision making in

choosing a course of action, e.g. coping with crowded activities, accumulation

62

of information, some perception of actions in relation to goals, deliberate

planning execution of action under supervision and can formulate and carry out

routines.

(4) Proficient stage: With active participation in clinical experiences, students

have learnt some nursing skills. Also with much clinical nursing practice,

individual student nurse develops intuition to guide his/her decisions and

develops the ability to formulate nursing plans according to the profession.

Candidate now has holistic view of situations, can prioritize important aspects

of activities, perceives deviations from the normal pattern and employs

maxims for guidance with meanings that adapt to the situation at hand.

(5) Expert stage: Candidates here transcend reliance on rules, guidelines and

maxims. They have intuitive grasp of situations based on deep, tacit

understanding. They have vision of what is possible and use analytical

approaches in new situations or in cases of problems.

63

Fig. 2: Model of the study of factors affecting clinical training of nursing

students. (Application of Dreyfus’s skill acquisition model)

The Dreyfus skill acquisition model as propounded by Benner (2004)

can be utilized to explain clinical training of students in nursing profession.

This training theory views each student and their stages of performance

uniquely and helps the teachers/ supervisors to attend to their needs

Clinical training of

students

Skill acquisition

Quality nursing care

(Independent variable)

Model of the study

(Intervening variables)

− teachers/supervisors,

− equipment/materials,

− techniques/measures

used for training,

− Students’ attitude.

(Study variables)

Proficient stage

Competent stage

Expert stage

Advanced Beginner

Novice’s stage

(Dependent variables)

64

individually and appropriately. It aims at upgrading the students from novice to

expert nurses by identifying the training needs at each stage and drilling the

students to acquire those needed skills before stepping forward to the next

stage.

In the model of study, the dependent variables are the stages of skill

acquisition which are novice stage, advanced beginner, competent stage,

proficient and expert stage. The intervening variables are the study variables

which include factors of adequate teachers/supervisors, equipment,

techniques/measures used for training and students attitude towards training.

The intervening variables are the factors that may affect clinical training of

nursing students either positively or negatively depending on the adequacy of

the intervening variables. The independent variable is the clinical training

offered to nursing students which involves skill acquisition that manifests in

the quality of nursing care rendered by students.

The model shows that adequacy and competency of the intervening

variables using the five stages approach of the model will affect clinical

training of nursing students. This is because at each stage, the students will be

drilled properly on the skills to be learnt before moving up to the next stage. In

other words, it is hypothesized that with experienced teachers and supervisors

using appropriate equipment with right training techniques and students being

interested in clinical experiences, students will acquire adequate and

appropriate nursing skills necessary for practice. Also, lack or

65

inappropriateness in any of the intervening variables or lack of proper

utilization of the stages of the model will result to poor acquisition of the

necessary nursing skills thereby leading to poor clinical nursing practice. The

model also showed that acquisition of nursing skill is a continuous process that

never ends but needs regular updating in order to remain relevant and

proficient in nursing profession.

Empirical review

A descriptive study done by Wuthiphong, Somsri and Suthineum (2009),

on factors influencing clinical learning behaviour of nursing students revealed

that students’ paying attention to clinical orientations, seminars/conferences

given to them before each clinical experience period and also that students

reporting when they noticed abnormal signs or symptoms in a patient to the

teachers or nurses around them helped them to learn better. The result also

indicated that inadequate number of experienced educators/clinical supervisors

were a negatively influencing factor to the clinical learning behaviour of

student nurses. This study showed also that motivating students and teachers to

act as role models to each other enhanced nursing skill acquisition.

A quantitative study done by Sumari-Ayo (2006) on factors influencing

clinical teaching of midwifery students in Tanzania, using three schools of

midwifery revealed that both the professional and educational qualification of

the tutors were low, tutors and the preceptors were overworked due to shortage

of staff, the schools’ clinical skill laboratory and the hospital wards lack basic

66

equipment and necessary supplies, there were no clinical accompaniment

guidelines. Also teachers in the classroom and supervisors in the clinical areas

do not cooperate with each other in training the students.

An exploratory study by Warner, et al (2010) showed that the clinical

experience placement duration of 6 weeks at a stretch for each clinical

experience period allowed students to learn better; supervisory relationship

between students and their supervisors was cordial and motivating; students

experienced conducive atmosphere in the wards while the role of their nurse

educators were not perceived in the clinical areas. Majority of their supervisors

were staff nurses in the wards while few were specialist nurses, 73% of the

students had schedule supervision sessions with their supervisors without their

nurse teachers. Also, 75% of the students recorded satisfaction with the

successful mentorship experiences they observed in the wards which enhanced

skill acquisition. They noted that their teacher’s role was mainly evaluative

role than supervisory roles. This implies that their teachers’ role did not

motivate them.

A qualitative study of nursing students experiences of clinical practice

done by Shariff and Masoum (2005) revealed that almost all the students

identified feeling anxious in their initial clinical placement; were worried about

giving the wrong information to the patients; lacked integration of theory into

clinical practice because of lack of clinical supervisors; ward staff nurses are

67

not concerned about what students learn and that staff nurses were not aware

of the skills and strategies necessary in clinical education.

A quantitative, descriptive, survey by Salmon and Gutema (2004) on

examining the experiences of student nurses on community based experience

(CBE) revealed that students’ participation and mentors’ willingness to answer

questions and the relevance of the placement areas were factors that facilitated

learning. While students reported that the factors that hindered learning were

difficulties of self-expression in a group, mentors emphasizing only mistakes

and weaknesses and the short time-frame for clinical experience due to

ongoing lectures during clinical experience periods.

Meechan, Jones, & Valler-Jones (2011) investigated on students'

perspectives of their clinical skills acquisition and knowledge during the

foundation year of their nursing programme, and whether this improved

students' levels of competence and confidence. Findings showed that students

identified that the curriculum supported the acquisition of clinical skills. This

indicates that the introduction of clinical skills teaching and assessment within

a university's simulation laboratory augmented with structured assessment

within the clinical environment improved the acquisition of clinical skills.

A descriptive study done by Williams & West (2011) titled,

“Approaches to nursing skills training in three countries” showed that the

central role of the clinical instructors is clinical training of students, the relative

freedom given to nursing students to participate in their own learning needs

68

helped their self confidence, interest and it increased learning. Also the

academic qualification and educational methodologies that were required for

clinical instructors helped them in drilling and concretizing nursing skills

taught to the nursing students during clinical training. It showed that the large

number of patients they took care of during their clinical experience helped

them to acquire nursing skill. In all the studied countries, the clinical

supervisors were large in number in the wards to ensure adequate control

teaching of students.

Study done by Dorthe and Regner (2011) on the practical skills of newly

qualified nurses showed that the newly qualified nurses do not feel equipped

when they finished their training as a direct consequence of the decrease in

practical training hours. The study also identified that the way nursing theory is

perceived and taught is problematic. The interviews done also revealed that the

nurses think that nursing theories should be applied directly in practice. This

misunderstanding is probably also applicable to the teachers of the theories.

Focus groups and questionnaires used for the study done by Bray, Flynn,

and Sanders (2011) aimed to explore the factors which influence student

nurses' ability to pass urethral catheter in children during their care. This aimed

at informing current pre-registration students’ clinical skill training and

education. The results showed that the students identified that their inability to

competently carry out urethral catheterization was influenced by lack of

exposure to the clinical skill and a need for specific paediatric focused training.

69

Evaluation of current catheterization training highlighted that, even after

training, only a small proportion of the student nurses felt confident to

catheterize children in practice because of lack of competence in that nursing

skill.

Summary of literature reviewed

Conceptual review of nursing education shows that nursing education

consist of acquisition of a body of knowledge which is partly delivered in a

classroom setting and an organized and supervised clinical training done in

different areas where student nurses do their clinical experiences. While

clinical training as part of nursing education consist of acquisition of

knowledge, skills and competences useful for rendering quality nursing care.

The patterns adopted for clinical training in Nigeria include, training in

the demonstration room, block study clinical training, study days clinical

training and consolidated clinical training. Some of the factors that affect

clinical training are the curriculum philosophy, the context for clinical training

and the human and material resources needed for effective clinical training.

Some of the challenges of clinical training in nursing include:

inadequate trained and experienced nurse educators, clinical nurses, clinical

supervisors etc both in the schools and in the clinical areas. There are also

theory- practice gap, inadequate funding, inadequate supervising of students

during their clinical experiences etc.

70

From the empirical review, it was observed that some studies had been

done on clinical training experiences of student nurses. The findings revealed

that a good orientation of the student nurses about what is expected of them

before the commencement of any clinical practice and enough period of time

for practice helped them to understand the clinical issues easily and better

when taught. Also, that good and experienced clinical teachers and preceptors,

conducive environment and adequate equipment are needed in the schools and

clinical areas to help the students integrate knowledge into clinical practical

skills. However, little has been done empirically in Nigeria to find out the

factors that do affect clinical training of nursing students. This is considered a

serious gap as identifying the factors that are involved in the training of student

nurses will help to acknowledge the necessity of providing those human and

material resources needed for adequate training of nursing students to enhance

nursing skill acquisition. It is this gap that informed the researcher’s choice of

the topic, factors affecting clinical training of nursing students. The model on

which the study was based is the Dreyfus model of skill acquisition as

developed by Benner (2004).

71

CHAPTER THREE

RESEARCH METHODS

This chapter presents the research design, area of the study, study

population, sample size and instrument for data collection, validity and

reliability of instrument, ethical consideration, procedure for data collection

and method of data analysis.

Research design

Descriptive cross-sectional survey design was used for the study. This

design was considered adequate because it has the ability to describe the

existing practice and reveals areas that need change. It also yields current and

prevailing information about the situation under study as it exists. Polit and

Beck (2003) in supporting this line of thought noted that, the descriptive

survey design involves a systematic collection, analysis, interpretation and

reporting of important facts about the existing event.

Area of study

The two areas of study were School of Nursing Afikpo (SON-A) in

Ebonyi State and Department of Nursing Sciences University of Nigeria Enugu

Campus (DNS-UNEC) in Enugu State of Nigeria. Ebonyi State with Abakaliki

as its capital has a land mass approximated at 5932km2. The State has

boundaries in the North with Benue State, East with Cross River, South with

Abia state and West with Enugu State. According to records from the ministry

of information Abakaliki, Ebonyi State has a population of 3 million people

and 13 Local Government Areas. These include, Afikpo North local

72

government area where the school for the study is situated (Ebonyi State

Ministry of Information, 2009). There is only one school of nursing in the State

which is, School of Nursing, Mater Misericordiae Hospital, Afikpo in Afikpo

North local government area. The school was selected and designated as

School (A) for the study. The school was established by the Roman Catholic

Mission in 1952 and it has been functioning since then. It is located along

Afikpo Ozizza road and is 75 kilometers from Abakaliki which is the capital of

Ebonyi State. This school was used for the study because of the decline in

practical performance of students in General Nursing Council Examination

especially in practical section.

The other area of study is Department of Nursing Sciences, University

of Nigeria Enugu Campus designated as school (B), in Enugu State with Enugu

as its capital. It has a land mass approximated at 7,161km2 (Enugu State,

Ministry of Information, 2007). The State has boundaries in the North with

Benue and Kogi States, East with Ebonyi State, South with Abia and Imo

States and West with Anambra State. It has a population of 5,590,513 people

and seventeen (17) local government areas, (Nigeria National Bureau of

statistics, Enugu 2005).

There are three Schools of Nursing and one University based

Department of Nursing in Enugu State namely: School of Nursing, Enugu

State University Teaching Hospital, Parklene, School of Nursing University of

Nigeria Teaching Hospital, Enugu, School of Nursing, Bishop Shanahan

Hospital, Nsukka and Department of Nursing Sciences, Faculty of Health

73

Sciences and Technology in University of Nigeria Nsukka, Enugu Campus

(UNEC).

This University was established in 1955 but was officially opened on 7th

October 1960 as the climax to the Nigerian independence celebration in the

Eastern region of Nigeria by her Royal Highness, the Princess Alexandra of

Kent who represented Her Majesty, Queen Elizabeth the second.

Department of Nursing Sciences UNEC came into existence during the

1982/ 83 academic session of the University. The department started with a 3-

year degree programme for registered nurses in three major areas namely,

Public Health Nursing, Nursing Education and Nursing Administration. Later

during the 2003/2004 academic session, the department started a 5-year

generic degree programme in Nursing Sciences for secondary school certificate

holders leading to the award of B.N.Sc degree. Department of Nursing

Sciences UNEC was used because of the reports from nurses in the clinical

areas indicating lack of clinical skills among the graduates of generic degree

programme.

These two schools for the study offer a three year higher diploma

General Nursing Education and a 5 year Generic Nursing degree programme

respectively. Nursing and Midwifery Council of Nigeria registers and issues

successful candidates that pass their professional qualifying examinations with

a professional nursing certificate and license to practice nursing in Nigeria.

School of Nursing Afikpo was chosen because it is the only school of nursing

in Ebonyi State offering a 3 year basic general nursing education while the

74

Department of Nursing Sciences is the only department offering a 5 year

Generic Nursing Programme in Enugu State. These two Institutions were

chosen to elicit the differences in the factors that affect clinical training of

nursing students in these institutions despite the diversities in ownership and

structure of their nursing programmes. The two nursing institutions were used

despite the diversities in ownership and structure of their nursing programmes

because of the following reasons: both Nursing Institutions are guided by the

same N&MCN Standard of Nursing Education and Practice; they use a similar

pattern of clinical training schedule which aims at imparting proper nursing

skills to the students; students from both institutions receive their clinical

training at the same type of clinical areas/settings e.g. hospital clinics etc; both

face the challenges of General Nursing Council Examination in which the

successful candidates are registered to practice as nurses by N&MCN;

candidates are also controlled after graduation by the same N&MCN and are

expected to render the same quality nursing care to clients in their different

areas of nursing practice.

Population of study

The total population for the study included all the academic staff and all

the students of the two institutions of study. The teachers’ total number was:

School of Nursing Afikpo, fourteen (14) and Department of Nursing Sciences

Enugu Campus, twenty (20). The students’ total number was: School of

Nursing Afikpo, two hundred and twenty eight (228) and Department of

75

Nursing Sciences Enugu Campus, four hundred and forty six (446). The total

population of teachers and students for the study from both schools were six

hundred and seventy four (674).

Target population

The target population constituted of all the academic staff of both

institutions and all the students in their second and third year of nursing

training in School of Nursing Afikpo and students in their 4th and 5

th year in the

Department of Nursing Sciences, UNEC. These cadres of students were

selected because they have had clinical exposures for more than one year,

therefore, they can give an experiential account of their clinical learning. The

target population of study was three hundred and thirty (330) comprising of

teachers and students from both nursing institutions. They were all considered

as eligible respondents, but inclusion and exclusion criteria were applied in

selecting the actual respondents. The reason for using all the respondents of the

study was because the number of the academic staff and the students’

population from both institutions were not too large to be managed for the

study.

76

Inclusion criteria: Respondents were:

- Teachers and students physically present in the schools during the study

period

- Students in the second and third years of nursing education in the nursing

school and students in their fourth and fifth years of study in the nursing

department of the university.

- Willingness to participate in the study.

Instrument for data collection

The instrument used for collection of relevant data from the respondents

was a researcher developed questionnaire titled: Questionnaire on factors

affecting clinical training of nursing students (QFACTNS). Items in the

questionnaire were generated from literature reviewed based on the objectives

set for the study. The questionnaire has thirty four (34) items in four sections

(A-D). Section A with seven (7) items dealt with the demographic data of the

respondents; section B with twelve (12) items sought information on the

administrative factors in relation to human resources and

infrastructure/equipment in the schools and clinical areas; section C with

eleven (11) items elicited information on the training/supervisory measures

used for clinical training of nursing students, while section D with four (4)

items dealt with the students’ factors affecting clinical nursing training.

Items thirteen (13) to thirty four (34) of the questionnaires were

constructed on a five-point likert scale which the respondents rated according

77

to their own dispositions. The items were rated by using 5, 4, 3, 2, and 1 which

were interpreted as follows:

5 - Strongly agree

4 - Agree

3 - Disagree

2 - Strongly disagree

1 - No opinion

Validity of the Instrument

A researcher-developed questionnaire, face and content validated by the

project supervisor and three other lecturers in the Nursing Sciences

Department were used for the study. The unsatisfactory items were either

restructured or deleted. Their modifications were reflected on the final draft of

the instrument.

Reliability of the instrument

The reliability of the questionnaire was established by test-retest

technique. Copies of the respective instrument were administered to twenty

five students and five teachers from School of Nursing, Our Lady of Lourdes

Hospital, Ihiala in Anambra State. The instrument was re-administered to the

same students and teachers after two weeks interval. Using the Pearson’s

product moment correlation (r), the test-retest scores were analyzed and the

coefficient of statistics reliability was 0.96 which indicated a high value. This

led to the conclusion that the instrument was reliable.

78

Ethical considerations

Ethical clearance was obtained from the Health Research Ethics

Committee of University of Nigeria Teaching Hospital Ituku- Ozalla in Enugu

state.

Administrative permission was obtained from the proprietor of the

School of Nursing Afikpo and the Head, Department of Nursing Sciences

University of Nigeria, Enugu Campus. The purpose of the study was explained

to the respondents and a signed informed consent was obtained from them.

Assurance was also given to them of the confidentiality of the information

given by them.

Procedure for data collection:

The researcher with the help of two trained research assistants

administered the copies of the questionnaire to the academic staff and the

students of both schools on different days. Copies of the questionnaire were

administered to the students in groups when they were in the classroom while

the teachers received their own questionnaire individually in their offices. The

administration and collection of the questionnaire lasted for three weeks.

Three hundred and thirty (330) questionnaires were administered while three

hundred and eleven (311) were duly completed and returned given a return rate

of 94.2%.

79

Method of data analysis

The data gathered were cleaned and analyzed with the help of software

SPSS version 17 using frequencies, percentages, standard deviation and mean

scores with a mean decision point of ≥ 3.0 for accepting a factor as promoting

students’ clinical training. While Z- test was used as inferential statistics. The

z- test was used to identify the differences with regard to the factors affecting

clinical training of nursing students between the two institutions at significant

level of p < 0.05. All the hypotheses were verified using Z- test tested at level

of significance of p < 0.05. Decision rule for testing of the hypotheses was Z-

test score > P-value which indicated rejection of the null hypothesis, where as

Z-test score < P-value indicated acceptance of the null hypothesis.

The five-point rating scale of Strongly Agree (SA), Agree (A), Disagree

(D), Strongly Disagree (SD) and no opinion (NOP) with values of 5, 4, 3, 2

and 1 respectively were used in scoring the items. This gave a total of 15 and a

mean of 3.0 when divided by 5. This was taken as the mean decision point. All

the items that attained mean scores of ≥ 3.0 were accepted by the respondents,

while mean scores < 3.0 were rejected by the respondents.

80

CHAPTER FOUR

ANALYSIS AND PRESENTATION OF RESULTS

This chapter dealt with the analysis and presentation of the results from

the data collected with the questionnaire and summary of the findings. The

results were presented using the research questions and hypotheses.

Out of the three hundred and thirty (330) copies of the questionnaire

administered, three hundred and eleven (311) were duly completed and

returned, giving a return rate of 94.2%. The two nursing institutions’ results

from section (B) were presented differently and titled:

Part one: School (A) --- School of Nursing, Afikpo (SON-A).

Part two: School (B) ---Department of Nursing Sciences, (DNS-UNEC).

Out of (311) respondents, 115 (36.9%) were from School of Nursing,

Afikpo, (School A), while 196 (63%) were from the Department of Nursing

Sciences University of Nigeria Enugu Campus (UNEC), (School B). Majority

of the respondents 283 (90.9%) were students while 28 (9%) were teachers.

Decision rule for the items which were constructed on a five-point likert

scale was based on mean score ≥ 3.0. Mean scores ≥ 3.0 were accepted as

positive responses while mean scores < 3.0 were accepted as negative

responses.

SECTION A: The responses to items 1-2 in the questionnaire were analyzed

to answer questions on Demographic factors of the students and presented in

table one.

81

Table 1: Demographic characteristics of the students

n = 283

Table 1 showed that, 177 (62.5%) students were from school (B) while

106 (37.4%) were from school (A). From both schools majority, 246 (74.6%)

were females, while the males were 37 (25.4%).

The responses to items 1, 4 - 6 in the questionnaire were analyzed to

answer questions on Demographic factors of the teachers and presented in

table 2.

Items School A School B f Percentage

Gender

Males

Females

Year of study

Year 2

Year 3

Year 4

Year 5

f

12

94

58

48

-

-

%

11.3

88.7

54.7

45.3

-

-

f

25

152

-

-

43

134

%

14.1

85.9

-

-

24.3

75.7

37

246

58

48

43

134

25.4

74.6

20.4

16.9

15.1

47.3

Total 106 37.4 177 62.5 283 100

82

Table 2: Demographic characteristics of the teachers:

n = 28

Out of the 28 teachers from both schools as displayed in Table 2, 6

(21.2%) were males while 22 (78.5%) were females. The highest educational

qualifications’ result revealed that school (A) has 2 (22.2%) teachers with RN

certificate only, 5 (55.5%) with B.Sc. Nursing, 2 (22.2%) with B.Sc. Anatomy

and no teacher with M.Sc. or PhD.

Items School A School B f Percentage

f % f %

Gender

Males

Females

3

6

33.3

66.7

3

16

15.8

84.2

6

22

21.4

78.5

Highest educational

qualification

RN only

B.Sc Nursing only

B.Sc Anatomy only

M.Sc. only

PhD

2

5

2

-

-

22.2

55.5

22.2

-

-

-

6

-

4

9

-

31.5

-

21.0

47.3

2

11

2

4

9

7.1

39.2

7.1

14.2

32.1

Years of teaching

experience

1-5

6-10

10 years – above

7

1

1

77.8

11.1

11.1

9

4

6

47.4

21.1

31.6

16

5

7

57

17.8

25.2

Teachers status

Lecturer

Clinical instructor

7

2

77.8

22.2

15

4

78.9

21.1

22

6

78.6

21.4

Total 9 32.1 19 67.8 28 100

83

While school (B), has 6 (31.5%) teachers with B.Sc. Nursing, 4 (21.0%)

with M.Sc. and 9 (47.3%) teachers with PhD.

In school (A), 7 (77.8%) of their teachers had 1-5 years of teaching

experience, 1 (11.1%) had 6-10 years of teaching experience and also only 1

(11.1%) teacher had 10-above years of teaching experience. While in school

(B), 9 (47.4%) of their teachers had 1-5 years of teaching experience, 4

(21.1%) had 6-10 years and 6 (31.6%) of their teachers had 10 years and above

teaching experience.

The result also showed that school (A) had 7 (77.8) lecturers and 2

(22.2%) clinical instructors. While school (B), had 15 (78.9%) lecturers and 4

(21.1%) clinical instructors. It was also noted from the Table that 22 (78.6%)

of the teachers from both schools were predominantly lecturers while clinical

instructors were 6 (21.4%).

84

SECTION B

PART ONE: SCHOOL (A) SON-A

SECTION B: Research question one: what are the administrative factors

that affect clinical training of nursing students?

The responses to items 7- 11 in the questionnaire were analyzed to

answer questions on administrative factors, (staffing) and presented in Tables 3

and 4.

Table 3: Respondents (School A) views on administrative factors (staffing)

affecting clinical training of nursing students

n = 115

Items Teachers Students Total %

The Number of teachers in this school is:

< 4

4 to 6

7 to 10

11 and above

Total

f % f %

1

97

14

3

115

.9%

84.3%

12.2%

2.6%

100%

0

1

5

3

9

0

11.1

55.6

33.3

1

96

9

0

106

9%

90.6

8.5

0

Which of these act as clinical supervisors in your

school: clinical instructors only

preceptors only

staff nurses in the clinical areas only

students are not being supervised

both clinical instructors and ward staff nurses

Total

0

0

4

0

5

9

0.

0

44.4

0

55.6

22

0

48

9

27

106

20.8

0

45.3

8.5

25.5

22

0

52

9

32

115

19.1%

0%

45.2%

7.8%

27.8%

100%

If you are supervised in the wards, how many of

the following staff supervises the students during

each shift in the wards?

Clinical instructors only 1

2

3

4

Total

2

2

1

0

5

40.0

40.0

20.0

0

49

0

0

0

49

100

0

0

0

51

2

1

0

54

44.3%

1.7%

0.8%

0%

46.8%

Preceptors only: 1 Total

0

0

0

0

0

0%

Staff Nurses in the wards or clinical areas only: 1

2

3

4

Total

8

1

0

0

9

88.8

11.1

0

0

75

0

0

0

75

100

0

0

0

83

1

0

0

84

72.1%

0.8%

0%

0%

72.9%

Table 3 showed that, 5 (55.6%) out of the 9 teachers indicated that the

number of their teachers were 7-10, 1 (11.1%) of them indicated that they had

85

4-6 teachers, while 3 (33.3%) teachers accepted that they had 11 and above

teachers in their school. While majority, 96 (84.3%) of their students indicated

that they had 4-6 teachers in their school.

The result showed also that 4(44.4%) of their teachers indicated that it

is only the clinical instructors that supervise the students, while 5 (55.6%)

teachers agreed that it was both the clinical instructors and the ward staff

nurses that supervise students during their clinical experiences. Forty eight

(45.3%) students indicated that it was only the ward staff nurses that

supervised them during clinical experiences, 22(20.8%) said that it was only

the clinical instructors, 9 (8.5%) stated that the students were not supervised,

while 27 (25.5%) of the students indicated that it was both the clinical

instructors and the ward staff nurses that supervised them during their clinical

experiences.

On the number of clinical instructors that follow students at each shift, 2

(40%) teachers answered that it was one clinical instructor, 2 (40%) indicated

that it was 2 clinical instructors and 1 (20%) teacher stated that it was 3 clinical

instructors that follow students at each shift during their clinical experience.

While all 49 (100%) of the students that answered in support of the clinical

instructors indicated that it was only one clinical instructor that supervised

them at each shift. The result showed also that the school had no preceptor

since nobody agreed to that statement. The Table further showed that 8

(88.8%) teachers stated that it was only 1 staff nurse that supervises students,

while only 1 (11.1%) teacher agreed that it was 2 staff nurses that supervise

students during each shift. On the other hand, all the 75 (100%) students that

86

answered in support of the staff nurses indicated that it was only one staff

nurse that supervise the students at each shift during their clinical experience.

Table 4: Respondents (School A) views on administrative factors, (staffing)

affecting clinical training of nursing students continued.

n = 115 Items Respondents NOP

1

SD

2

D

3

A

4

SA

5

Mean

Score

SD Decision

Teachers in this

school are enough

to handle the

subjects in the

school.

Teachers

Students

0

1

1

27

7

78

1

0

0

0

3.00

2.73∗∗∗∗

.500

.469

accepted

rejected

Teachers in this

school are

involved in

supervision of

students in the

clinical areas.

Teachers

Students

1

1

1

76

2

3

5

26

0

0

3.22

2.51∗∗∗∗

1.093

.876

accepted

rejected

Group mean score = 2.8

Decision mean =≥≥≥≥ 3.0, NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected

The result in Table 4 showed that only the teachers accepted that

teachers are enough to handle the subjects in the school and also that teachers

are involved in supervision of students in the clinical areas with mean scores of

3.00 and 3.22 respectively. While the students did not accept both statements

with mean scores of 2.73 and 2.51 respectively which are less than the

accepted decision mean score (≥ 3.0). Group mean is 2.8, which is < 3.0.

87

The responses to items 12-18 in the questionnaire were analyzed to

answer questions on administrative factors, (Infrastructure/Equipment) and

presented in Table 5.

Table 5: Respondents (School A) views on administrative factors,

(infrastructure/equipment) affecting clinical training of nursing students.

n= 115

Items Respondents NOP

1

SD

2

D

3

A

4

SA

5

Mean

Score

SD Decision

This school has practical

laboratory for students’

clinical practice.

Teachers

Students

0

0

0

0

0

0

4

52

5

54

4.56

4.51

.500

.469

accepted

accepted

The laboratory has a large

space for all the students

to observe what is being

thought.

Teachers

Students

0

0

1

0

1

2

1

30

6

52

4.33

4.26

1.118

.808

accepted

accepted

The school laboratory has

enough equipment that can

enable many students to

practice procedures during

the same period.

Teachers

Students

0

0

0

0

2

1

0

77

7

28

4.33

4.25

1.323 accepted

.496 accepted

The hospital has enough

needed equipment for the

number of students on

each shift to practice with

while on clinical

experience.

Teachers

Students

0

1

4

72

5

33

0

0

0

0 2.56∗∗∗∗

2.30∗∗∗∗

.527 rejected

.481 rejected

Students/clients ratio in

each ward during clinical

periods was enough for

students practice.

Teachers

Students

0

1

5

10

0

4

4

0

0

0

1 2.44∗∗∗∗

2.06∗∗∗∗

.527 rejected

.361 rejected

The school has a library

with current nursing text

books for references.

Teachers

Students

0

1

2

2

3

3

4

24

0

72

3.22

4.58

.833 accepted

.729 accepted

Teachers and students use

the library.

Teachers

Students

0

0

0

99

1

7

3

0

5

0 2.56∗∗∗∗

2.07∗∗∗∗

.726 rejected

.250 rejected


Decision mean = ≥≥≥≥ 3.0

NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected

88

Table 5 showed that both the teachers and the students are in agreement

with the following statements: that their school has practical laboratory for

students’ clinical practice, (mean scores 4.56 and 4.51respectively), that the

laboratory has a large space for all the students to observe what is being taught,

(mean scores 4.33 and 4.26respectively), that the school laboratory has enough

equipment that can enable many students to practice procedures during the

same period ( mean scores 4.33 and 4.25 respectively) and that the school has a

library with current nursing text books for references, (mean scores 3.22 and

4.58 respectively). The mean scores are ≥ 3.0 which is the decision mean

score.

Also both respondents did not accept that the hospital has enough needed

equipment for the number of students on each shift to practice with while on

clinical experience, (mean scores 2.56 and 2.30 respectively), that students/clients

ratio in each ward during clinical periods is enough for students practice, (mean

scores 2.44 and 2.06 respectively) and that teachers and students use the library,

(mean scores 2.56 and 2.07 respectively). The mean scores are less than the

decisions mean score of ≥ 3.0. The Table showed that the respondents accepted 4

items and rejected 3 items with group mean score 3.4 which is ≥ 3.0.

89

Research question two: what are the training/supervisory factors that

affect clinical training of nursing students?


answer questions on training/supervisory factors, and presented in Table 6.

Table 6: Respondents (School A) views on training/supervisory factors that

affect clinical training of nursing students

n= 115 Items Respondents NOP

1

SD

2

D

3

A

4

SA

5

Mean

Score

SD Decision

The school authority does the

following to ensure that students

acquire the required nursing skills:

Organize clinical conferences

/seminars for the students.

Teachers

Students

0

0

1

27

3

53

4

26

1

0

3.56

2.99∗∗∗∗

.882

.710

accepted

rejected

Encourage students to participate in

planning of clinical teaching

programmes.

Teachers

Student

0

0

2

28

4

77

2

1

1

0

3.22

2.75∗∗∗∗

.972

.459

accepted

rejected

Provide mentors and preceptors in

each shift to coach the students on the

nursing skills.

Teachers

Students

0

0

5

98

4

7

0

1

0

0 2.44∗∗∗∗

2.08∗∗∗∗

.527

.312

rejected

rejected

Give students assignments during

clinical periods at least once a week.

Teachers

Students

0

0

3

74

5

7

1

25

0

0 2.78∗∗∗∗

2.54∗∗∗∗

.667

.853

rejected

rejected

Teachers do finish teaching their

courses and practical before students

go to the clinical areas.

Teachers

Students

0

0

6

99

3

6

0

0

0

1 2.33∗∗∗∗

2.08∗∗∗∗

.500

.368

rejected

rejected

Students do repeat demonstration

after teacher’s own teaching during

each procedure.

Teachers

Students

0

1

0

0

0

0

4

28

1

0

4.56

4.70

.527

.572

accepted

accepted

Clinical orientations are given to the

students at the beginning of each

clinical posting.

Teachers

Students

0

1

1

53

3

50

4

2

1

0

3.56

2.50∗∗∗∗

.882

.556

accepted rejected

The ward staff nurses follow the

correct procedure in carrying out their

job to enable students to learn and do

the right thing.

Teachers

Students

0

1

1

25

0

74

7

6

1

0

3.89

2.80∗∗∗∗

.782

.542

accepted rejected

The ward staff nurses do supervise the

students during each procedure.

Teachers

Students

0

1

1

24

0

55

7

26

1

0

3.89

3.00

.782

.717

accepted

accepted

Supervisors do evaluate students’

clinical experience at the end of each

clinical period.

Teachers

Students

0

1

2

47

6

57

1

1

0

0 2.89∗∗∗∗

2.55∗∗∗∗

.601

.537

rejected

rejected

The school provides field

trips/excursions as varied teaching

and learning opportunities.

Teachers

Students

0

1

1

1

2

29

1

71

5

4

4.11

3.72

1.167

.598

accepted

accepted




90

Responses on Table 6 showed that only the teachers accepted that the

school authority organizes clinical conferences/seminars for the students,

(mean score 3.56), and that the school authority encourages students to

participate in planning of clinical teaching programmes, (mean score 3.22),

while the students rejected both statements with mean scores of 2.99 and

2.75respectively. The result showed also that only the teachers indicated that

clinical orientations are given to the students at the beginning of each clinical

posting, (mean score 3.56) and that the ward staff nurses follow the correct

procedure in carrying out their job to enable students to learn and do the right

thing, (mean score 3.89). On the other hand, students did not accept both

statements with mean scores of 2.50 and 2.80 respectively.

Both teachers and students did not accept the following statements: that

the school authority provides mentors and preceptors in each shift to coach the

students on the nursing skills, (mean scores 2.44 and 2.08 respectively); gives

students assignments during clinical periods at least once a week, (mean scores

2.78 2.54 respectively) and that the teachers do finish teaching their courses

and practical procedures before students go to the clinical areas, (mean scores

2.33 and 2.08 respectively). It is noted also that both teachers and students did

not accept that supervisors evaluate students’ clinical experience at the end of

each clinical period with mean scores of 2.89 and 2.55 respectively.

Both the teachers and the students in school (A) also accepted that,

students are allowed to repeat demonstration after teacher’s own teaching

during each practical procedure, (mean scores 4.56 and 4.70 respectively), that

the ward staff nurses do supervise the students during each procedure, (mean

scores 3.89 and 3.00 respectively) and that the school provides field

91

trips/excursions as varied teaching and learning opportunities (mean scores

4.11 and 3.72 respectively). The group mean is 3.0 which correspond with the

decision mean score ≥ 3.0.

Research Question three: what are the students’ factors that affect clinical

nursing training?


answer questions on students’ factors and presented in Table 7.

Table 7: Respondents (school A) views on students’ factors affecting

clinical training of nursing students

n= 115


1

SD

2

D

3

A

4

SA

5

Mean

Score

SD Decision

Every student attended

clinical experiences

regularly as scheduled.

Teachers

Students

0

1

1

0

4

2

4

7

0

96

3.33

4.86

.707

.786

accepted

accepted

Every student attempted the

clinical assignments/ texts

given to them.

Teachers

Students

0

1

1

1

4

25

4

52

0

27

3.33

3.97

.707

.786

accepted

accepted

The students make use of

the equipment in the school

laboratory for clinical

practice on their own.

Teachers

Students

0

2

2

4

5

76

2

23

0

1

3.00

3.16

.707

.588

accepted

accepted

Students do the following

during clinical experiences:

Self assessment of their

clinical performance.

Teachers

Students

0

1

1

5

6

94

1

2

1

4

3.22

3.03

.833

.506

accepted

accepted

Accepts corrections and ask

their ward staff nurses

questions during clinical

experience.

Teachers

Students

0

1

0

0

5

2

1

26

3

77

3.78

4.68

.610

.972

accepted

accepted

Students use the nursing

care procedures book during

clinical experience as a

guide for practice.

Teachers

Students

0

1

0

1

5

2

1

75

3

27

3.78

4.19

.972

.603

accepted

accepted




92

Table 7 showed that both the teachers and the students are in agreement

that, every student attends clinical experiences regularly as scheduled, (mean

scores 3.33 and 4.86 respectively), every student attempts the clinical

assignments/ texts given to them, (mean scores 3.33 and 3.97 respectively) and

that the students make use of the equipment in the school laboratory for

clinical practice on their own, (mean scores 3.00 and 3.16 respectively). The

result showed also that the respondents accepted that, Students do self

assessment of their clinical performance, (mean scores 3.22 and

3.03respectively), that the students accept corrections and ask their ward staff

nurses questions during clinical experience with mean scores of 3.78 and 4.68

respectively and that students use the nursing care procedures book during

clinical experience as a guide for practice with mean scores of 3.78 and 4.19

respectively. The group’s mean score for students’ factors is 3.6. The research

question three is accepted because the group’s mean score is 3.6 and is greater

than the accepted benchmark of 3.0.

93

PART TWO, SCHOOL (B):

Research question one: what are the administrative factors (staffing) that

affect clinical training of nursing students?


answer questions on administrative factor, (staffing) and presented in Tables 8

and 9.

Table 8: Respondents (School B) views on administrative factors (staffing)

affecting clinical training of nursing students

n = 196

Items Teachers Students Total %

The Number of teachers in this school is:

< 4

4 to 6

7 to 10

11 and above

Total

f % f %

1

5

63

127

196

0.5%

2.6%

32.1%

64.8%

100%

1

1

3

14

19

5.3

5.3

15.8

73.7

0

4

60

113

177

0.0

2.3

33.9

63.8

Which of these act as clinical supervisors in your school:

clinical instructors only

preceptors only

ward staff nurses only

students are not being supervised

both clinical instructors and ward staff nurses

Total

7

0

2

2

8

19

36.8

.0

10.5

10.5

42.1

75

1

14

84

3

177

42.4

0.6

7.9

47.5

1.7

82

1

16

86

11

196

41.8%

0.5%

8.2%

43.9%

5.6%

100%

If you are supervised in the wards, how many of the

following staff do supervise the students during each shift

in the wards?

Clinical instructors only

1

2

3

4

Total

9

6

0

0

15

60

40

.0

.0

22

52

3

1

78

28.2

66.7

3.8

1.3

31

58

3

1

93

33.3%

62.4%

3.2%

1.1%

100%

Preceptors only: 1 Total

0 0

1 100

1

100%

Staff Nurses in the wards or clinical areas only: 1

2

3

4

Total

8

1

1

0

10

80

10

10

.0

8

4

2

3

17

47.1

23.5

11.8

17.6

16

5

3

3

27

59.3%

18.5%

11.1%

11.1%

100%

94

Table 8 showed that majority, 14 (73.7%) out of the 19 teachers stated

that the number of their teachers were 11 and above, while only 3 (15.8%)

indicated that teachers are 7-10 in number. On the other hand majority, 113

(63.8%) out of the 177 students noted that they had 11 and above teachers in

their school. While 60 (33.9%) indicated that they were 7-10 teachers in their

school.

The result showed also that 7(36.8%) of their teachers indicated that it

was only the clinical instructors that supervise the students, while 8 (42.1%)

teachers agreed that it was both the clinical instructors and the ward staff

nurses that supervise students during their clinical experiences. While 75

(42.4%) of the students noted that it was only the clinical instructors that

supervise the students, 14 (7.9%) indicated that it was only the ward staff

nurses that supervised them during clinical experiences but 84 (47.5%) stated

that the students were not supervised during clinical experiences.

On the number of clinical instructors that follow students at each shift, 9

(60%) teachers out of the 15 teachers that answered this item indicated that it

was one clinical instructor while 6 (40%) indicated that it was 2 clinical

instructors that follow students at each shift during their clinical experience.

While majority 52 (66.7%) of the students that answered clinical instructors

indicated that it was only two clinical instructors that supervised them at each

shift. The result showed also that the school may not have any preceptor since

only one student agreed to that statement.

95

The table further showed that 8 (80%) teachers out of the 10 teachers

that answered for number of nurses in the wards stated that it was only 1 staff

nurse that supervise students. On the other hand, out of the 17 (100%) students

that answered in support of the staff nurses, 8 (47.1%) students indicated that it

was only one staff nurse that supervise students during each shift while 4

(23.5%) indicated that it was two staff nurses that supervise the students at

each shift.

Table 9: Respondents (School B) views on administrative factors (staffing)

affecting clinical training of nursing students continued.

n = 196 Items Respondents NOP

1

SD

2

D

3

A

4

SA

5

Mean

score

SD Decision

Teachers in this

school are enough

to handle the

subjects in the

school.

Teachers

Students

1

6

5

5

9

118

1

34

3

14

3.00

3.25

1.106

.782

accepted

accepted

Teachers in this

school are involved

in supervision of

students in the

clinical areas.

Teachers

Students

1

7

9

104

5

15

3

41

1

10

2.68∗∗∗∗

2.68∗∗∗∗

1.003

1.052

rejected

rejected

Group mean score =2.9

Criterion mean = ≥≥≥≥ 3.0


Table 9 showed that both the teachers and the students are in

agreement that the teachers in the school are enough to handle the subjects

in the school with mean scores of 3.00 and 3.25 respectively. While they

did not accept that teachers in the school are involved in supervision of

students in the clinical areas with mean scores of 2.68 and 2.68

respectively. The group mean is 2.9 and is < 3.0.

96

Research question one continued: what are the administrative factors

(Infrastructure/Equipment) that affect clinical training of nursing

students?


answer questions on (Infrastructure/Equipment) and presented in Table 10.

Table 10: Respondents (School B) views on administrative factors

(Infrastructure/Equipment) affecting clinical training of nursing students

n = 196


1

SD

2

D

3

A

4

SA

5

Mean

Score

SD Decision


laboratory for students’

clinical practice.

Teachers

Students

1

0

0

9

2

2

13

138

3

28

3.89

4.05

.875

.611

accepted

accepted


space for all the students

to observe what is being

thought.

Teachers

Students

1

6

8

66

9

89

1

14

0

2 2.53∗∗∗∗

2.66∗∗∗∗

.697

.722

rejected

rejected


enough equipment that

can enable many students

to practice procedures

during the same period

Teachers

Students

1

3

12

61

4

98

1

12

1

3

2.42*

2.72∗∗∗∗

.902

.689

rejected

rejected



number of students on

each shift to practice with

while on clinical

experience.

Teachers

Students

2

2

3

31

6

119

7

21

1

4

3.11

2.97∗∗∗∗

1.100

.656

accepted

rejected

Students/clients ratio in

each ward during clinical

periods is 1:5 for practice

under supervision.

Teachers

Students

1

8

2

19

7

59

7

85

2

6

3.37

3.35

1.012

.886

accepted

accepted




Teachers

Students

1

9

1

44

7

23

9

92

1

9

3.42

3.27

.902

1.053

accepted

accepted


the library. Teachers

Students

2

17

0

5

1

12

16

135

0

8

3.63

3.63

.955

.980

accepted

accepted


Decision criterion mean = ≥≥≥≥ 3.0, NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected

97

Result in Table 10 showed that teachers and students in school (B) are in

agreement that their school has practical laboratory for students’ clinical

practice, (mean scores 3.89 and 4.05 respectively), that students/clients ratio in

each ward during clinical periods were enough for practice under supervision,

(mean scores 3.37 and 3.35 respectively), that the school has a library with

current nursing text books for references, (mean scores 3.42 and 3.27

respectively) and that teachers and students make use of the library, (mean

scores 3.63 and 3.63 respectively).

The table showed also that both respondents did not accept that the

laboratory has a large space for all the students to observe what is being taught,

(mean scores 2.53 and 2.66 respectively) and that the school laboratory has

enough equipment that can enable many students to practice procedures during

the same period with mean scores 2.42 and 2.72 respectively. But only the

teachers accepted that the hospital has enough needed equipment for the

number of students on each shift to practice with while on clinical experience

with mean score of 3.11 while the students rejected that statement with mean

score of 2.97.The group mean for administrative factors

(infrastructure/equipment) is 3.1 and is ≥ 3.0 which is the decision mean.

98

Research Question two: What are the training/supervisory factors used

for clinical training of nursing students?

The responses to items 19-29 were analyzed to answer questions on

training/supervisory factors in Table 11.

Table 11: Respondents (School B) views on training/supervisory factors affecting

clinical training of nursing students n = 196


1 SD

2

D

3

A

4

SA

5

mean

Score

SD Decision


following to ensure that students

acquire the required nursing

skills:

Organize clinical conferences/

seminars for the students.

Teachers

Students 1

4

2

8

4

59

10

91

2

15

3.53

3.59

1.020

.800

accepted

accepted

Encourage students to participate

in planning of clinical teaching

programmes.

Teachers

Students 1

5

6

47

8

78

3

33

1

14 2.84∗∗∗∗

3.02

.958

.941

rejected

accepted

Provide mentors and preceptors

in each shift to coach the

students on the nursing skills.

Teachers

Students 1

4

10

108

5

35

2

27

1

3 2.58∗∗∗∗

2.53∗∗∗∗

.961

.840

rejected

rejected

Give students assignments

during clinical periods at least

once a week.

Teachers

Students 1

2

8

53

7

80

2

38

1

4 2.68∗∗∗∗

2.94∗∗∗∗

.946

.806

rejected

rejected

Teachers do finish teaching their

courses and practical before

students go to the clinical areas.

Teachers

Students 1

4

8

118

8

30

0

21

2

4 2.68∗∗∗∗

2.45∗∗∗∗

1.003

.818

rejected

rejected

Students do repeat

demonstration after teacher’s

own teaching during each

procedure.

Teachers

Students 1

3

0

5

1

33

11

74

6

62

4.11

4.06

.937

.896

accepted

accepted

Clinical orientations are given to

the students at the beginning of

each clinical posting.

Teachers

Students 1

4

0

3

1

6

11

137

6

27

4.11

4.02

.937

.678

accepted

accepted


correct procedure in carrying out

their job to enable students to

learn and do the right thing.

Teachers

Students 1

4

1

31

10

71

6

69

1

2

3.26

3.19

.872

.817

accepted

accepted

The ward staff nurses do

supervise the students during

each procedure.

Teachers

Students

2

3

1

14

8

11

1

7

39

1

10

3.21

3.22

1.032

.740

accepted

accepted

Supervisors do evaluate

students’ clinical experience at

the end of each clinical period.

Teachers

Students

1

6

4

47

9

73

4

38

1

13

3.00

3.03

.943

.956

accepted

accepted

The school provides field

trips/excursions as varied

teaching and learning

opportunities.

Teachers

Students

2

8

0

15

1

22

11

124

5

8

3.89

3.62

1.150

.879

accepted

accepted

99

Respondents’ views as shown in Table 11 revealed that both teachers

and students accepted that, the school authority organizes clinical

conferences/seminars for the students, (mean scores 3.53 and 3.59

respectively), that students are allowed to repeat demonstration after teacher’s

own teaching during each procedure, (mean scores 4.11 and 4.06 respectively),

that clinical orientations are given to the students at the beginning of each

clinical posting, (mean scores 4.11 and 4.02 respectively) and that the ward

staff nurses follow the correct procedure in carrying out their job to enable

students to learn and do the right things,( mean scores 3.26 and 3.19

respectively).

It is also noted from the table that both respondents are in agreement that

the ward staff nurses do supervise the students during each procedure, (mean

scores 3.21 and 3.22 respectively), that the supervisors do evaluate students’

clinical experience at the end of each clinical period, (mean scores 3.00 and

3.03 respectively) and that the school provides field trips/excursions to the

students as varied teaching and learning opportunities, (mean scores 3.89 and

3.62 respectively).

The table showed also that both teachers and students did not accept the

following: that the school authority provides mentors and preceptors in each

shift to coach the students on the nursing skills, (mean scores 2.58 and 2.53

respectively), that supervisors give students assignments during clinical

periods at least once a week, (mean scores 2.68 and 2.94 respectively) and that

100

the teachers do finish teaching their courses and practical before students go to

the clinical areas, (mean scores 2.68 and 2.45 respectively).

Only the teachers did not accept that the school authority encourage

students to participate in planning of clinical teaching programmes, (mean

score 2.84), while the students accepted that the school authority encourage

students to participate in planning of clinical teaching programmes, with mean

score 3.02. The group mean for training/supervisory factors is 3.2 and is ≥ 3.0

which is the decision mean.

101

Research Question three: what are the students’ factors that affect clinical

nursing training?


answer questions on students’ factors and presented in Table 12.

Table 12: Respondents (school B) views on students’ factors affecting clinical

training of nursing students n= 196


1

SD

2

D

3

A

4

SA

5

mean

score

SD Decision

Every student attends

clinical experiences


Teachers

Students

1

2

1

0

8

113

7

46

2

16

3.42

3.42

.961

.703

accepted

accepted

Every student attempts

the clinical assignments

/texts given to them.

Teachers

Students

1

5

1

3

5

18

10

137

2

4

3.58

3.86

.961

.697

accepted

accepted

The students make use

of the equipment in the

school laboratory for

clinical practice on their

own.

Teachers

Students

1

8

8

104

9

36

1

25

0

4

2.53∗∗∗∗

2.51∗∗∗∗

.697

.873

rejected

rejected

Students do the

following during

clinical experiences:



Teachers

Students

2

16

3

93

9

13

3

41

2

14

3.00

2.68∗∗∗∗

1.106

1.159

accepted

rejected

Accepts corrections and

ask their ward staff

nurses questions during

clinical experience.

Teachers

Students

2

16

0

3

3

3

10

45

4

110

3.74

4.30

1.147

1.199

accepted

accepted

Students use the

nursing care procedures

book during clinical

experience a s a guide

for practice.

Teachers

Students

2

18

0

2

8

2

7

137

2

18

3.35

3.76

1.065

1.011

accepted

accepted

Group mean score =3.3

Decision criterion mean = ≥≥≥≥ 3.0,


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Table 12 showed that both teachers and students in school (B) accepted

that every student attends clinical experiences regularly as scheduled, (mean

scores 3.42 and 3.42 respectively) and that every student attempts the clinical

assignments/texts given to them with mean scores of 3.58 and 3.86

respectively. Both respondents are also in agreement that students accepted

corrections and ask their ward staff nurses questions during clinical experience,

(mean scores 3.74 and 4.30 respectively) and that students use the nursing care

procedures book during clinical experience as a guide for practice with mean

scores of 3.35 and 3.76 respectively.

The result showed also that both teachers and students did not accept

that the students make use of the equipment in the school laboratory for

clinical practice on their own with mean scores of 2.53 and 2.51 respectively.

Only the teachers indicated that the students do self assessment of their clinical

performance, mean score 3.00 while the students did not accept that they do

self assessment of their clinical performance with mean score of 2.68. The

group mean for the students’ factors is 3.3 and is ≥ 3.0 which is the decision

mean.

Testing of hypotheses:

The decision rule: If Z- test score > P-value (critical value), the null

hypotheses is rejected which showed that there is significant statistical

difference on the item between the two schools. But if the Z-test score is < P-

103

value (critical value), the null hypothesis is accepted which shows that there is

no significant statistical difference on the item between the two schools

Hypotheses one: There is no significant statistical difference in the

administrative factors affecting clinical training of nursing students

between the two schools under study.

The responses for items 10-18 in the questionnaire were tested to verify

this hypothesis and presented in Table 13.

Table 13: Z- test significance of difference between the two institutions of study as

regard the administrative factors affecting clinical nursing training

n = 311

Items Z – test

scores

P- value Decision

Teachers in this school are enough to handle the

courses in the school.

- 5.766 .000∗∗∗∗ rejected

Teachers in this school are involved in

supervision of students in the clinical areas.

-.968 0.334 accepted

This school has practical laboratory for students’

clinical practice.

6.930 .000∗∗∗∗ rejected

The laboratory has a large space for all the

students to observe what is being thought.

18.120 .000∗∗∗∗ rejected

The school laboratory has enough equipment that

can enable many students to practice procedures

during the same period.

19.757 .000∗∗∗∗ rejected

The hospital has enough needed equipment for

the number of students on each shift to practice

with while on clinical experience.

-8.805 .000∗∗∗∗ rejected

Students /clients ratio in each ward during

clinical experience is enough for students

practice.

-14.359 .000∗∗∗∗ rejected

The school has a library with current nursing text


10.540 .000∗∗∗∗ rejected

Teachers and students use the library. -16.241 .000∗∗∗∗ rejected

Level of significance = P <<<< 0.05

NOTE: ∗∗∗∗ indicates significance difference at P <<<< 0.05

Z - test score >>>> P- value (critical value) = reject the hypothesis

104

The result in Table 13 showed that significant statistical differences exist

between the schools with regard to administrative factors affecting clinical

training of nursing students. In all the nine items on administrative factors

affecting clinical nursing training, statistical significance mean differences

exist between the schools except in one (item 2). But both schools had average

mean scores < 3.0 in item 2, which implies that both disagreed that the teachers

are involved in clinical supervision of the students. There is no significant

statistical mean difference between the schools in item number 2, (Z=.968,

P=0.334).

For items 1, 6, 7&9, school (A) had mean scores < 3.0, therefore,

rejected all the assertions while school (B) had mean scores ≥ 3.0, so agreed

with the statements. There were significant statistical differences between the

schools in these items, so the null hypothesis is rejected. The alternative being

that school (A) do not have enough teachers to handle school courses, not

enough equipment for students clinical practice in the hospital, inadequate

number of clients for students practical training and that teachers and students

do not make use of the school library.

School (B) had mean scores < 3.0 in items 4 & 5, while school (A) had

mean scores ≥ 3.0 in those items. There were significant statistical mean

differences between the schools, so the null hypothesis is rejected. The

105

alternative is that school (B) did not have a large practical laboratory and not

enough equipment for students practice in the laboratory.

For item 3 and 8, both schools had mean scores ≥ 3.0, therefore they

agreed with the assertions that they have practical laboratory and library with

current nursing text books for students use. However, school (A) mean scores

on the two items (4.54; 3.85) were significantly higher than that of school (B),

(3.97; 3.35). The z-test scores were z = 6.932, p= 0.000; z = 10.540, p = 0.000

respectively. Therefore the null hypothesis is rejected and the alternate

hypothesis is accepted. School (A) agreement is stronger.

106

Hypotheses two: There is no significant statistical difference in the

training/supervisory factors affecting clinical training of nursing students

between the two schools under study.


hypothesis 2 in Table 14.

Table 14: Z- test significance of differences between the two institutions with

regard to the training/supervisory factors affecting clinical nursing training

n = 311

Items Z – test P- value Decision

The school authority does the following:

organize clinical conferences/seminars for the

students

-5.940 .000∗∗∗∗ rejected

Encourage students to participate in planning of

their clinical training programmes

-2.328 .021∗∗∗∗ rejected

Provide mentors and preceptors in each shift to coach

the students on the nursing skills.

-5.092 .000∗∗∗∗ rejected

Give students assignments during clinical periods at

least once a week.

-3.667 .000∗∗∗∗ rejected

Teachers do finish teaching their courses and clinical

procedures before students go to the clinical areas.

-4.468 .000∗∗∗∗ rejected

Students are allowed to demonstrate after teachers’

own teaching during each procedure.

6.723 .000∗∗∗∗ rejected

Clinical orientation is given to the students at the

beginning of each clinical posting.

-17.942 .000∗∗∗∗ rejected

The ward staff nurses follow the correct

Procedures in carrying out their job to enable

students to learn and do the right thing.

-3.512 .001∗∗∗∗ rejected

The ward staff nurses do supervise the students

during each procedure.

-1.666 .097 accepted

Supervisors do evaluate students’ clinical experiences

at the end of each clinical period.

-4.653 .000∗∗∗∗ rejected

The school provides field trips/ excursions as varied

teaching and learning aid.

1.083 .280 accepted



Z- test score >>>> P- value (critical value) = reject the hypothesis

107

The result in Table 14 showed that significant statistical differences

existed between the schools with regard to training/supervisory factors

affecting clinical training of nursing students. In all the eleven items on

training/supervisory factors affecting clinical nursing training, statistical

significance mean differences existed between the schools except in two items

(items 9 & 11) but both schools had average mean scores ≥ 3.0 which implies

that both schools agreed that the ward staff nurses do supervise students during

each procedure in the clinical areas and that the school provide field

trips/excursions as varied teaching and learning aid. There is no significance

statistical mean difference between the schools, (z = -1.666, p = 0.097 &

z = 1.082, p = .280).

For items 3, 4& 5, both schools had mean scores < 3.0, therefore they

disagreed with the following statements: that the school authority provides

mentors and preceptors in each shift to coach students, gives students

assignments at least once a week and that teachers finish teaching their courses

before students go to the clinical areas. However, school (B) mean scores in the

three items (2.54, 2.91 & 2.47) were a bit higher, (z = -5.092, p= .000;

z = -3.667, p= .000; z = -4.469, p= .000), than that of school (A) (2.11, 2.56 &

2.10). Therefore the null hypothesis is rejected and the alternate hypothesis is

accepted.

For items 1 & 6, both schools had mean scores > 3.0, therefore they

agreed with the statements that the school authority organize clinical

108

conferences/seminars for the students and that students do repeat

demonstration after teachers’ own teaching during each procedure. However,

school (B) mean score in item 1 (3.59) is a bit higher than the mean score of

school (A) 3.03, (z = -5.940; p = .000). Also, school (A) mean score in item 6

(4.69) is a bit higher than the mean score of school (B) 4.06, (z = 6.723; p =

.000). Therefore, the null hypothesis is rejected and the alternate hypothesis is

accepted.

For items 2, 7, 8 & 10, school (A) had mean scores < 3.0, therefore

rejected all the assertions while school (B) had mean scores ≥ 3.0, therefore,

accepted the statements. There were significant statistical differences (z =

-2.328, p = .021; z = -17.942, p = .000; z = -3.512, p = .001 & z = -4.653,

p = .000) between the schools in these areas. So the null hypothesis is rejected.

The alternative being that in school (A), the school authority do not encourage

students to participate in planning of their clinical training programmes,

clinical orientation are not given to the students at the beginning of each

clinical posting, ward staff nurses do not follow the correct procedures in

carrying out their job and also that the supervisors do not evaluate students

clinical experiences at the end of each clinical period. Therefore, the null

hypothesis is rejected and the alternate hypothesis is accepted.

109

Hypotheses three: There is no significant statistical difference in students’


institutions under study.


this hypothesis 3 in Table 15.

Table 15: Z- test significance of differences between the two institutions of

study with regard to the students’ factors affecting clinical nursing training

n = 311 Items Z – test

score

P- value Decision

Every student goes for his/her clinical experiences


15.832 .000∗∗∗∗ rejected

Every student attempts the clinical assignments /

tests given to them.

1.017 .310 accepted

Students make use of the equipment in the school

laboratory for clinical practice on their own.

7.045 .000∗∗∗∗ rejected

Students do the following during their clinical

experience: Self assessment of their clinical

performance.

2.879 .004∗∗∗∗ rejected

Accept corrections and ask ward staff questions. 2.927 .003∗∗∗∗ rejected

Students use the nursing care procedure book during

clinical experience as a guide for practice.

4.084 .000∗∗∗∗ rejected



Z- test score >>>> P- value (critical value) = reject the hypothesis

The result in Table 15 showed that significant statistical differences exist

between the schools with regard to the students’ factors affecting clinical

training of nursing students. In all the six items on the students’ factors

110

affecting clinical nursing training, statistical significance mean differences

exist between the schools except in one (item 2) but both schools had average

mean scores ≥ 3.0 which implies that both schools agreed that every student

attempts the clinical assignments/tests given to them. There is no significant

statistical mean difference between the schools, but (z = 1.017, P = .310).

For items 3 & 4, school (B) had mean scores < 3.0, while school (A) had

mean scores ≥ 3.0. There are significant statistical mean differences

(z = -5.092, p = .000 & z = -3.667, p = .000) between the schools, so the null

hypothesis is rejected. The alternative is that in school (B), students do not

make use of the equipment in the school laboratory for clinical practice by

themselves and students do not perform self assessment of their clinical

performance.

For item 1, 5 and 6, both schools had mean scores ≥ 3.0, therefore they

agreed with the assertions that every student goes for his/her clinical

experiences regularly as scheduled, students accept corrections and ask ward

staff nurses questions and that students use the nursing care procedure book

during clinical experience as a guide for practice. However, school (A) mean

scores on the three items 4.74; 4.61 & 4.16 were significantly higher than that

of school (B), 3.42; 4.24 & 3.72, the z-test is (z= 15.832, p = 0.000; z =2.927,

p = .003 & z = 4.084, p = 0.000). Therefore the null hypothesis is rejected and

the alternate hypothesis is accepted. School (A) agreement is stronger.

111

Summary of the Findings

The following were the major findings from both nursing institutions

which contributed positively or negatively to acquisition of nursing skills.

In school (A), respondents accepted that the following factors contributed

positively to students’ clinical training:

- Provision of practical laboratory with enough equipment for students

use for practice,

- Practical laboratory with large space for all the students to observe what

is being thought,

- Library with current nursing text books for references,

- Students repeat demonstration of practical procedures after teachers own

teaching,

- Provision of field trips/excursions as training opportunities,

- Involvement of ward nurses in students’ clinical training,

- Students’ attendance of clinical experiences regularly and doing

assignments given to them,

- Students’ ability to practice on their own and using their procedure

manual as a guide for practice (mean scores ≥3.0).

In school (A), respondents accepted that the following factors contributed

negatively to nursing students’ clinical training:

- Inadequate number of teachers to handle subjects in the school,

- Teachers’ non involvement in clinical supervision of students,

112

- Teachers’ inabilities to finish teaching their courses before students go to

the clinical areas,

- Inadequate equipment in the clinical areas for students practice,

- Students’ non usage of the school library,

- Insufficient client in the clinical areas for students practice

- Inadequate number of supervisors for clinical training of students,

- Non provision of mentors and preceptors to coach nursing students,

- Supervisors’ inability to give proper supervision and evaluation of clinical

performance of students

- Students’ non participation in planning their clinical programme (mean

scores < 3.0).

In school (B), factors that contributed positively to nursing students’ clinical

training are:

- Adequate number of teachers to handle the subjects in the school,

- Provision of practical laboratory for students use,

- Provision of library with current nursing text books,

- Teachers and students usage of the school library,

- Sufficient client in the clinical areas for students practice

- Organizing clinical conferences/seminars for students,

- Involvement of ward nurses in students training,

- Students repeat demonstration of procedures,

- Students’ attendance of clinical experiences regularly

113

- Students’ usage of their procedure manual as a guide for practice

In school (B), factors that contributed negatively are:

- Teachers’ non involvement in clinical supervision of students,

- Teachers’ inabilities to finish teaching their courses before students go to

the clinical areas,

- Small spaced practical laboratory that do not allow students to observe

what is being thought,

- Inadequate equipment in their school laboratory and in the clinical area,

- Inadequate number of nursing text books in their library,

- Inadequate number of supervisors for clinical training of students,

- Non provision of mentors and preceptors to coach nursing students,

- Supervisors’ inability to give proper supervision and evaluation of clinical

performance of students

- Students’ non participation in planning their programme,

- Students’ inability to practice on their own and to do self assessment of

their clinical performance (mean scores < 3.0).

- Findings revealed that there were significant statistical differences between

the two nursing institutions as regards the administrative,

training/supervising and students’ factors affecting clinical training of

nursing students as evidenced by the Z-test score > P-values in most items

tested in the three hypotheses.

114

CHAPTER FIVE

DISCUSSION OF FINDINGS

This chapter presents discussion of major findings, implications for

nursing education and practice, recommendations, limitations to the study,

suggestions for further studies, summary and conclusion.

Administrative factors that affect clinical training of nursing students in

the schools’ laboratory and in the clinical areas

The findings of this study showed that the number of students (283)

outweighed that of the teachers (28) with ratio as 1: 10; (school (A) 1: 6 and

school B 1: 5) when considered that only a section of the students were used

for the study. This implies that the teachers will find it difficult to manage the

students both in the schools and in the clinical areas. This finding can be

considered as one of the constraining factors to appropriate acquisitions of

nursing skills because the teachers may not finish the course work on time and

the students may not be adequately supervised during clinical experiences.

This affirms the statement made by Lohor (2005) that where the number of

nurse teachers is inadequate, the few available ones are faced with the

problems of coping with a large class of students for the classroom work and

clinical supervision. Also, the study done by Withiphong et al (2009) revealed

that inadequate number of teachers/supervisors were a significantly influencing

factor to the clinical learning behaviour of student nurses.

115

The findings also showed that the students were not properly supervised

during clinical experience; that it was mainly one or two clinical instructors

that supervise students, (school (A) 44.3%, school (B) 62.4%), for both the

teachers and students. Although the ward staff nurses are there, few

occasionally do supervise the students. This may be due to shortage of these

nurses or overloaded work. Lack of proper supervision will lead to wrong

learning of nursing skills, laziness and non motivation on the part of the

students. This leads to truancy during clinical experiences. This finding is in

line with some of the findings identified in the studies done by Sumari-Ayo

(2006) and Sharif and Masoum (2005). They reported overwork of teachers

and preceptors due to shortage of staff and that the ward staff nurses were not

concerned about what students learn. Staff nurses were busy with their duties

therefore not able to assume both educational and service role while on duty.

The situation where there is inadequate supervision of students implies that the

students are on their own without guidance. This poses serious danger to both

the patients and the students and also hinders learning/acquisition of required

nursing skills which are needed for quality nursing care.

Although the study revealed that only the respondents in school (B)

accepted that their teachers were enough to handle the subjects in the school,

(mean score 3.23), both schools rejected the issue of their teachers being

involved in supervision of students in the clinical areas, (mean scores, school

A= 2.57, school B= 2.68). This implies that what the students learnt in the

116

classroom are not made concrete in real life situations in the wards, thereby

creating theory–practice gap and poor nursing skill learning. This study

supported some of the findings in the studies done by Warner et al (2010) and

that of Sharif and Masoum (2005) which showed that majority of the

supervisors were ward staff nurses without the nurse teachers. Their teachers

acted mainly as practical examination evaluators but not as clinical

facilitators/supervisors. Also, in the study the students were confused because

what they learnt in the classroom were different from what was done in the

clinical areas, leading to lack of integration of theory into clinical practice.

In relation to the items on infrastructure/equipment, the respondents

accepted that both schools had practical demonstration laboratory, (mean

scores, 4.51 and 4.03) but only school (A) had a large spaced practical

laboratory and enough equipment needed for practice, (mean scores, 4.27 and

2.65). They also accepted that both schools had a library each, (mean scores,

4.48 and 3.29) but only the teachers and students in school (B) made use of

their library, (mean scores, 2.10 and 3.63 respectively). But they rejected the

statement that the hospitals had enough needed equipment for students

practice. Also, only school (B) had enough clients for students practice under

supervision, (mean scores, 2.09 and 3.35). Where nursing schools have enough

of these items, it showed that students can participate actively using the

equipment when procedures are being taught. Where there are lacks of

equipment in the wards, this makes what is learnt in the school not to be put

117

into practice in real situations in the wards. This jeopardizes learning and skill

acquisition because practice makes perfect and better nursing care delivery.

This supported the report from Sumari-Ayo (2006) and Bray et al (2011)

studies which indicated that the school skill laboratory and the hospital wards

lacked equipment and other necessary supplies, which do not help students to

practice and concretize what they learnt in the classroom. They noted also that

student’s inability to competently carry out urethral catheterization after their

graduation was influenced by lack of exposure to the clinical skills. Also

Searle (2000) identified lack of equipment/infrastructure as one of the

constraining factors affecting clinical training of students in nursing

profession.

Training/supervisory factors that affect the clinical training of students in

the schools and in the clinical areas

This study revealed that respondents from both institutions accepted that

the school authority organized clinical conferences/seminars for the students,

(mean scores, 3.03 and 3.59), but school (A) rejected the issue of encouraging

students to participate in planning their programmes, (mean scores, 2.78 and

3.01). By organizing conferences and seminars for the students, they expose

the students to varieties of knowledge and experience which helped them to

interact with other people, develop critical thinking skills and also up date

them with current issues in nursing and other professions. Wuthiphong et al

(2009), Career et al (2012) and Williams et al (2011) observed that when

118

students paid attention to orientations, seminars and conferences they learned

better and acquire more knowledge and skills. However, when students are not

involved in planning of their programme, it decreases their zeal and interest in

their affairs. Students become dependent on the planners and are uninterested

in such programme. This finding is contrary to the assertions of Quinn (2001)

that supervisors and the student nurses should participate in the planning and

preparation of the programme for clinical training so as to foster their interest

and active involvement in the activities.

The findings also revealed that the respondents rejected the statement

that the school authority provides mentors and preceptors to coach students

while on clinical experience, (mean scores, 2.11 and 2.54); that supervisors

give students clinical assignments during clinical periods, (mean scores, 2.56

and 2.91) and also that their teachers finish teaching their courses and practical

teaching before the students go to the clinical areas, (mean scores, 2.10 and

2.47). This confirms that there is not much supervision and assessment of

students’ clinical training. It showed also that due to lack of mentors and

preceptors in the clinical areas, there will not be ongoing assessment and direct

correction of students during nursing procedures in the clinical areas. The

students do not have mentors to imitate and be motivated to work. There is no

individual student follow up, proper drilling and on the spot correction and

guidance as can be given by the preceptors. Not given assignment to students

will not help to identify the weak points and strengths of the students learning

119

so as to know how to help each student. Inability of the teachers to finish

teaching their courses before students go for clinical experience may be due to

overload of work; lack of motivation of the teachers or nonchalant attitude of

the teachers. This will not help to concretize the skills since students had no

prior knowledge of the topic in theory. The findings are contrary to the

assertions of Shariff et al (2005) that provision of professional nurses such as

mentors, preceptors and clinical instructors as supervisors of students during

clinical experience periods ensure efficiency and make sure that supervisors

impart the right knowledge, develop the needed nursing skills and mental

faculty of the students they supervise. The findings also differ from the

findings of Warner et al (2010) which noted that 75% of the students recorded

satisfaction with the successful mentor ship experience they observed in the

wards which enhanced nursing skill acquisition. Findings differ from the result

of the study done by Meechan et al (2011) which identified that the

introduction of clinical skills teaching and assessment within a university’s

simulation laboratory and augmented with structured assessment within the

clinical environment improved the acquisition of clinical skills.

The study further showed that the respondents from both schools

accepted that the students repeat demonstration after the teachers own

teaching, (mean scores, 4.69 and 4.06), that in school (B), clinical orientations

were given to the students at the beginning of each clinical posting, (mean

score, 4.03) and that the ward staff nurses followed the correct procedure in

120

carrying out procedures, (mean score, 3.20), while these were not done in

school (A), (mean scores, 2.58 and 2.89). Both schools accepted that the ward

staff nurses supervise the students during each procedure. In line with the

above statement, giving of clinical orientation to students before each clinical

posting gives a clear knowledge and direction to the students and minimizes

the tension or fear of making mistakes; that the ward staff nurses’ followed the

correct procedures; made it easier for the students to imitate and learn better

and faster. These findings support the findings in the study done by Career et al

(2012), that allowing students to participate during clinical procedures

facilitates concreteness of skills. Also, that students paying attention to the

clinical orientations given to them help the students to learn better as identified

in a study done by Wuthiphong et al (2009). Ward nurses following the correct

procedure promoted the assertion posited by Waldock (2010) which stated that

registered nurses working with student nurses in the clinical settings have a

major influence on the students’ performance. This is because they are more

with the students than their other supervisors. They can promote and facilitate

students learning or cripple them.

The result that staff nurses supervise students in the wards is in line with

what Warner et al (2010) identified in their study, that majority of their

supervisors were staff nurses in the wards while few were specialist nurses.

But the finding is not in agreement with the study done by Shariff et al (2005)

121

which stated that the ward staff nurses were not concerned about what students

do or learn.

The respondents from both schools rejected the idea that their

supervisors do evaluate students’ clinical experiences at the end of each

clinical period. This may be due to lack of supervisors or overload of the few

available ones. This will not give clue to students’ performance and areas of

deficiencies. Inability of the supervisors to evaluate students’ clinical

experiences goes contrary to the findings in the study carried out by Warner et

al (2010) where students rated the supervisory relationship between them and

their supervisors very high because of the mutual relationship between them. It

is also not in line with the assertions of Oermann et al (2009) which advocated

evaluation technique as a toll for identifying the deficiencies and areas of

weakness and strength in clinical training.

The respondents accepted that the schools provide field trips/ excursions

as a means of exposing the students to other learning opportunities in other to

fortify learning, (mean scores, 3.75 and 3.64). This is in line with the

objectives of clinical nursing education as identified by Quinn (2001) and it

includes provision of orientation to students, provision of accessible and

appropriate varied training opportunities.

The students’ factors that may affect clinical training of nursing students

Findings of this study, suggested that teachers and students from both

schools identified less problems on students factors affecting clinical training

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of nursing students. This may be due to the students’ interests and likeness of

nursing profession or may be to avoid being reprimanded by the school

authorities. Attending clinical experiences as scheduled, (mean scores, 4.74

and 3.42) is in line with the stipulations of the N&MCN concerning minimum

hours for clinical experiences, (4,400 hours) which qualifies students for taking

the professional examinations, (Curriculum for General Nursing Education in

Nigeria 2001). Students attempting clinical assignments/tests given to them

form part of the formative and summative evaluation of their clinical

experiences, as noted by Oermann et al (2009).

The findings of this study also identified that students in school (B) do

not use equipment in the laboratory to practice on their own and also that they

do not do self assessment of their clinical performance, (mean scores, 2.51 and

2.71). This may be due to lack of interest or lack of motivation of the students.

The rejection of these assertions do not support the finding in the study done

by William et al (2011) which indicated that a relative freedom to students and

motivation for students to pursue their own learning needs and practices on

their own helped their self confidence and increased nursing skill acquisition.

Also the findings are contrary to what Gardner and Supplee (2010) noted in

their study that interest in ones training is a key factor for effective teaching

and learning.

Result of this study showed that the respondents from both schools

agreed that students do accept corrections and ask questions to their ward staff

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nurses, (mean score, 4.61 and 4.24). Also they accepted that students use the

procedure book during clinical experiences, (mean score, 4.16 and 3.72). This

may be due to their interest in clinical training and motivation given to them by

their supervisors in the wards. The results are in support with what

Wuthiphong et al (2009) reported in their study, that students reporting

immediately when they notice abnormal signs and symptoms in a patient to

their supervisors or ward nurses around them, helped students to learn better.

Also Carer et al (2012) noted in their study that mentors’ willingness to answer

students’ questions facilitated learning. The findings are also in line with the

assertions of Melone (2010) that students’ performance in nursing clinical

experiences depends on the students’ interest in the course. Accepting the

usage of procedure books during clinical experience as a guide for practice is

in line with the N&MCN mandate to each nursing school. It serves as

directives or patterns of carrying out nursing care procedures, (Curriculum for

General Nursing Education in Nigeria, 2001).

Hypotheses one:

There is no significant statistical difference in the administrative factors

affecting clinical training of nursing students between the two nursing

institutions under study?

The null hypothesis one (Ho1) was rejected indicating that there are

significant statistical differences between the two schools as regards the

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administrative factors affecting clinical training of nursing students and

alternate hypothesis accepted.

In testing hypothesis one, the results showed that there were significant

statistical differences between the schools in all the items of the administrative

factors affecting clinical training of nursing students except in one item, item

2, (z = -.968, p = 0.334).This result implies that the result is similar in both

schools, because their teachers are not involved in supervision of students in

the clinical areas with mean scores, school (A) = 2.57 and school (B) =2.68.

Findings showed that there were significant statistical differences

(z = - 5.766; p = 0.000) between the two schools of study as regards whether

the schools have enough teachers to handle the subjects in the schools. School

(A) had not enough teachers compared to school (B). Nursing schools not

having enough teachers to teach in the schools leads to poor quality nursing

education and practice because of poor nursing knowledge and nursing skills

acquisition.

The result also showed that there is no significant statistical difference

(z = -.968, p = 0.334) between both schools as regards teachers being involved

in supervision of students. Both schools had mean scores < 3.0 in that item.

This implies that the teachers in both schools do not supervise their students

while on clinical experience, thereby creating theory practice gap. This is in

line with what Sharif et al (2005) described as lack of integration of theory into

clinical practice. These findings agreed with the findings of Sumari-Ayo

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(2006) and Warner et al (2010), which indicated that the teachers were

overworked due to shortage of teachers and that the students rated their nurse

teachers role of supervision low during clinical experiences because of the

teachers non involvement in their clinical supervision. Also Lohor (2005)

emphasized that one of the constraints of clinical training of nursing students is

inadequate number of trained teachers both in the classroom and in the clinical

areas where students do their experiences.

The result indicated that in school (B), the size of the school practical

laboratory is not large enough to accommodate their students’ population and

there is also not enough equipment for practice in the practical laboratory.

Practical laboratory without a large space will make it difficult for the students

to observe the teacher clearly during demonstration of practical procedures and

this hinders nursing skill acquisition. This is in line with the finding of Sumari-

Ayo (2006) who found that the school practical laboratory was small and lack

basic equipment for practice thereby hindered most of the students from

observing what the teacher demonstrated and led to lack of nursing skill

acquisition. WHO (1999) indicated that appropriate clinical learning facilities

such as spacious practical laboratory should always be made available to make

learning concrete and easier to reproduce when needed.

There is also a significant statistical difference (z = 8.805, p = 0.000)

between the schools in the aspect of having enough needed equipment in the

hospital wards. School (A) does not have enough equipment in the hospital for

126

practice. The implication is that even if the students do the practice in the

school, it cannot be repeated in the hospital wards because of lack of

equipment and lack of clients in the wards so as to concretize the procedures

learnt theoretically. This finding is in line with that of Sumari-Ayo (2006) who

reported that the hospital wards lack basic equipment and necessary supplies

leading to lack of skill acquisition. This finding is one of the constraints of

clinical nursing training identified by Searle (2000) which indicated that

clinical nursing training need varieties of equipment for students’ practice.

This helps learning to be concrete and enhances nursing skill acquisition.

There is significant statistical difference (z = -14.359, p = 0.000)

between the schools on the statement of student/clients ratio. The deficiency

was reported in school (A). This lack of clients hinders students from the use

of life objects to practice with under supervision so as to concretize theories

learnt in the classroom. The finding is against N&MCN educational standard

for student /clients’ ratio to ensure adequate training of students (Curriculum

for General Nursing Education, in Nigeria, 2001). Williams and West (2011)

stated that the number of patients which students took care of during their

clinical experiences help them to acquire the required nursing skills.

Although there is a significant statistical difference (z=10.540, p=.000)

between the schools on whether the two institutions have libraries, the

difference is not much as seen in the mean scores of school (A) = 4.48 and

school (B) = 3.29 which are above mean decision point. But there is an

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outstanding difference in the usage of the library, because teachers and

students in school (A) do not make use of their own library, (mean score 2.10).

The finding indicated that School (A) has a library with current nursing text

books but both the teachers and the students do not make use of the library.

While as school (B) respondents reported that they have a library and they

make use of the books as references. None usage of the school library is not in

line with the assertion of Melone (2010) which stated that good library and

equipment used in the nursing schools and clinical areas are regarded as the

life wire of any nursing school to achieve a meaningful nursing education.

Also WHO (1999) indicated that appropriate clinical learning facilities such as

laboratory, library, equipment and supplies should always be made available

and maintained regularly to make learning concrete and easier to reproduce

when needed.

Hypotheses two:

There is no significant statistical difference in the training/supervisory


nursing institutions under study?

In nine out of the eleven items on training/supervisory factors,

significant statistical differences exist between the institutions. Therefore, the

null hypothesis two (Ho2) was rejected in these and alternate hypothesis

accepted as regards to the training/supervisory factors affecting clinical

training of nursing students.

128

Significant differences between the schools were noted in the aspects of

organizing clinical conferences/seminars for the students and encouraging

students to participate in planning their clinical teaching programmes as

presented in Table 14, (z = -5.940, p = .000 & z = -2.328, p = .021). When

students partake in making decisions concerning them, they have great interest

in the programme and also achieve self worth or self confidence which

motivates learning. Gardner et al (2010) noted that involvement of nursing

students from the onset of planning any programme enable them to discover

solutions to problems by themselves and not to be mere speculators. This

heightens their interest in such endeavor. Salmon and Gutema (2004) asserts

that students’ participation and mentors willingness to answer questions are

some of the factors that facilitate nursing skill acquisition.

There is also significant statistical difference, (z = -5.092, p = .000)

between the schools on the item of provision of mentors and preceptors in both

schools. Lack of or inadequate number of these personnel hinders direct

teaching and supervision of students during their clinical experience. This

leads to poor nursing skill acquisition and is inferred in nursing practice. This

is in line with the findings of Wuthiphong et al (2009) which indicated that

inadequate number of experienced teachers, mentors, preceptors and

supervisors were a significantly influencing factor to the clinical training

behaviour of student nurses. This is an opposite of what Warner et al (2010)

identified in their study where 75% of the students recorded satisfaction with

129

the successful mentorship experiences they observed in the wards which

enhanced skill acquisition.

Findings revealed significant statistical differences (z = -3.667, p = .000

& z = -4.468, p = .000) between the schools on the item of supervisors giving

assignments to students during clinical experience periods and on whether

teachers do finish teaching the courses before students proceed for clinical

experience. However, both schools failed in fulfilling both items as both

schools scored below the mean decision point, (school (A) =2.56 &2.10,

school (B) 2.91&2.47). Inability of the supervisors to give students

assignments will not allow the supervisors to identify the weak points in each

student’s skill acquisition, leading to poor learning and practice. Also, where

teachers do not finish teaching the courses before students proceed for clinical

experiences, leaves the students ignorant of that knowledge and needed nursing

skills. This leaves students to learn on the job, students lack interest in the

work and play truancy during clinical experiences. Inability of the teachers to

finish their courses before clinical experiences kept the students feeling

anxious in their initial clinical placement, worried about giving wrong

information to the clients and lacks integration of theory into clinical practice

as identified by Sharif et al (2005) in their qualitative study.

Result showed that School (A) students were allowed to repeat

demonstration after teachers own teaching more than students from school (B),

mean scores 4.69 & 4.06. When students repeat what the teacher has

130

demonstrated, students learn better and the teacher has the opportunity to

correct mistakes on the spot to prevent students from learning wrongly. But

where this is not done, students stick to the wrong procedures they may have

learnt from anybody. When students demonstrate after teachers own teaching,

it forms part of the advanced beginners’ stage of the Dreyfus model of skill

acquisition which propels students up to the next level of skill learning,

(Benner, 2004). Teachers’ drilling of instructions, demonstrating and

practicing procedures with adequate equipment and supervision of students,

helped the students to leave the former stage of novices’ stage to advanced

beginner’s stage, (Benner 2004).

The results of the items about giving clinical orientation to students and

whether the ward staff nurses follow the correct procedures, indicated

significant statistical differences (z = -17.942, p = .000 & z = -3.512, p = .001)

between the schools. In school (A), students score of 2.89 in item (8) implies

that ward staff nurses do not follow the correct procedure in doing their jobs.

Students learn by imitation, therefore where the ward staff nurses who are

more with the students do not follow the correct procedures while doing their

jobs, students learn the wrong procedures. Not giving clinical orientation

before students proceed for clinical experiences, make students to be ignorant

of the learning expectations in the wards, hence the students are not motivated

and they lack interest. These results differed from the findings of Wuthiphong

et al (2009) which indicated that students were given orientation and that

131

students paying attention to orientation before clinical practical experience

helped them to learn better. Also Quinn (1996) highlighted that one of the four

key elements that affect clinical training of students is that they learn also by

imitation as the teaching learning support from their ward staff nurses.

In both schools the ward staff nurses supervise the student nurses in the

clinical areas. This is an asset and an observation of the ethical legal duty of

accountability by the trained nurses. This is in line with the findings of Warner

et al (2010) where students identified that majority of their supervisors were

staff nurses in the wards while few were specialist nurses. On the contrary

Sharif et al (2005) found out that the ward staff nurses were not concerned

about what the students learn. They are busy with their duty schedule and

cannot combine supervisors’ role with their duty. Waldock (2010) asserted that

registered nurses working with student nurses in the clinical settings have a

major influence on students’ performance as they are more with the students

than their other supervisors.

There is significant differences (z score = -4.653, p-value =.000)

between the two schools on whether the supervisors evaluate students during

clinical experiences. School (A) rejected that statement. Lack of evaluation of

students’ performance may be due to shortage of supervisors or inexperience

or both. This does not reflect proper evaluation of students clinical

performance, teaching and prompt correction of students. Evaluation helps to

132

elicit the extent to which learners have achieved the educational objectives,

(Dermann et al 2009).

There is no significant differences (z = 1.082, p = .280) between the two

schools as regards providing field trips/excursions for the students. Both

schools provide this experience as both had mean scores of 3.75 & 3.64. Field

trips/excursions provide students with more avenues of learning and makes

knowledge more concrete as they see, touch or work with concrete objects. It

provides interactive medium for students as they chat and interact with other

people not from their locality or school. Providing field trips/excursions for the

students is in line with the objectives of clinical nursing education as identified

by (Quinn 2001). The provision of orientation to students, accessible and

appropriate varied training opportunities helped to concretize learning, (Quinn

2001).

Hypotheses three:

There is no significant statistical difference in students’ factors affecting

clinical training of nursing students between the two nursing institutions

under study?

In five out of the six items in students’ factors affecting clinical training

of nursing students, significant statistical differences were observed between

the schools. Therefore the null hypothesis three (Ho3) was rejected indicating

that there are significant statistical differences between the two schools as

regards to the students factors affecting clinical training of nursing students.

133

Table (15) showed significant statistical difference (z = 15.832,

p = .000) between the schools on the statement that students go for their

clinical experiences as scheduled. This also showed that School (A)

respondents attended clinical experience regularly more than students from

school (B). This may be due to the location of the clinical area of students in

school (B) which is far from the university. There is no significant statistical

difference (z = 1.017, p = 0.310) between the two schools on the item of

whether every student attempts the clinical assignment or test given to them.

Students attempting clinical assignments/tests given to them form part of the

formative and summative evaluation of their clinical experiences, as noted by

Oermann et al (2009).

The results showed that School (A) students make use of the equipment

in the laboratory on their own while those from school (B) do not make use of

the equipment in the laboratory on their own, (z =7.045, p =.000). This may be

for fear of the equipment been lost when students use them alone. Where

students repeat procedures on their own, it helps them to learn the skills better.

There is Significant statistical differences (z = 2.879, p = .004;

z = 2.927, p = .003 &z = 4.084, p = .000) between the schools as noted on the

items of whether the students do self assessment of their performance, accept

corrections and ask questions to their ward staff nurses and also use their

procedure books as a guide for practice. The difference is more pronounced on

the item about students doing self assessment of their performance with mean

134

scores of, school (A) 3.04 and school (B) 2.71 respectively. While other items

implied greater magnitude of agreement as both schools scored above 3.0

mean decision point. Melone (2010) asserted that students’ performance in

clinical experience depended on the interest and importance which the students

attach on it and are not afraid to ask questions during clinical experiences due

to attitude of the ward staff nurses that supervise and teach them in the clinical

areas. These staff nurses may not know what to teach them, the students also

react by not asking those nurses questions. In school (B), their school

procedure manual differs from that of their hospital which is the same with that

from school of Nursing, University of Nigeria Teaching Hospital (UNTH).

Students may be confused on the requirement of each manual. Students’ use of

the procedure book during their clinical experiences as a guide for practice is

in line with N&MCN requirements. Each training school should develop their

procedure manual for clinical training based on N&MCN curriculum of

nursing education, (curriculum for General Nursing Education in Nigeria,

2001).

Implications for Nursing

The implications of the findings to nursing education and practice are:

− High teacher-student ratio (above 1:10), in the nursing schools creates

over load of work to the teachers and will lead to improper attendance to

students’ learning needs

135

− Large space in the schools’ practical laboratory will enable the students

to have a clear view of what the teacher is demonstrating thereby students

learn the required skills better.

− Lack of adequate equipment in the nursing school practical laboratory and

in the clinical areas jeopardizes psycho-motor skill development.

− Library with adequate nursing text books in the schools helps both the

students and teachers as a reference base when they make use of them.

− None involvement of teachers in the supervision of students in their

clinical areas creates theory- practice gap leading to poor or wrong

learning of nursing skills.

− Students not supervised during their clinical experience expose both

students and patients to serious dangers leading to poor acquisition of

nursing skills and poor quality nursing care.

− Not giving students assignments/tests and also not evaluating students

during their clinical experience period do not give room for proper

evaluation of the students’ strengths and weaknesses during training.

− Lack of mentors and preceptors in the clinical areas leads to poor drilling

or coaching of students on the required nursing skills.

− Inadequate number of clients in the wards restricts students’ actual

practice with real life objects which hinders proper skill acquisition.

136

− None involvement of students in planning their activities leads to lack of

interest in actual carrying out of the plan.

− Students’ attendance to their clinical experiences as scheduled exposes

them to many real life situations which will help them to concretize what

they learnt in the classroom.

− Students doing practice on their own helps them to learn better and

remember easily what they have been taught.

− Using the procedure book helps the students and teachers to follow each

nursing procedure as programmed and helps one to be acquainted with the

nursing knowledge and skills.

− The significant statistical differences identified in this study showed that

procedure for clinical training in schools of nursing is different from that

of the university based nursing programme. This calls for a way of

resolving the issues identified by N&MCN.

Recommendations

It is evidenced that some factors affecting clinical training of nursing

students in School of Nursing, Afikpo (SON-A) and Department of Nursing

Sciences, Enugu Campus (DNS-UNEC) are poor and inadequate therefore,

may hinder nursing skill acquisition. It is therefore recommended that:

1. Adequate, experienced and qualified nurse educators and clinical

instructors are necessary in any nursing institution and such should be

employed and maintained by the competent authorities.

137

2. School authority should plan and follow their curriculum based on

N&MCN programme in such a way that teachers can finish their courses

earlier before students go for such clinical experience so as to be equipped

with enough knowledge and information.

3. The school authority should realize that the duration of clinical experience

period at each session at a stretch influences the level of overall students’

clinical skill acquisition. Therefore, clinical experience period should not

be too short a period.

4. Nurse educators should teach and follow up students to the clinical areas

using the set up guidelines for theory and clinical teaching to prevent

theory- practice gap and not go there to police the students.

5. All involved in the training and supervision of students should be updated

with current trends in nursing and research through seminars/conferences

so that they can impart such knowledge to the students.

6. Qualified preceptors and clinical instructors should be employed and

motivated for clinical facilitation/supervision of students during their

clinical experiences.

7. Adequate number of qualified nurses should be employed to work in

different places where student nurses do their clinical experience to

facilitate supervision and teaching in the clinical areas.

138

8. Adequate and spacious practical laboratories should be constructed and

equipped with enough equipment to enhance skill acquisition in school

(B).

9. Provision of adequate equipment and supplies in the wards are important

to facilitate competent teaching and learning in the clinical areas.

10. Enough clients are needed in the clinical areas to facilitate and concretize

knowledge and nursing skills in school (A).

11. Behaviour modification to change inferiority complex, bias and other

negative attitudes that hinder students, teachers and clinical staff nurses

interactions and communication in the clinical areas should be taught

during training.

12. Supervisors should evaluate students’ performance regularly to elicit areas

of weakness and give proper corrections and directions.

13. Mentorship relationship help students in their professional development

and skill acquisition, therefore such people should be provided in the

clinical areas.

14. Nursing students should be involved actively in planning their

programmes to ensure their active participation and interest in such

activities.

15. Clinical orientation of students before clinical practice should be

organized in such a way that all the students should participate actively.

139

16. N&MCN to provide a clearly written standard guidelines and polices on

clinical training of student nurses.

Limitations to the Study

One of the constraints in this study is lack of co-operation from some of

the respondents in giving answers to the questionnaire items. This is because

they see it as exposing the activities in their schools. Some of the students were

fearful as they do not know how the school authority will see some of their

answers. Some students were on clinical experience which has different time

schedules. While some of the lecturers were very busy and needed to be given

more time to attend to the questionnaire.

Suggestions for Further Studies

Further studies could be carried out in the following areas:

- Factors affecting student nurses behaviour during their clinical training

could be studied by other researchers.

- Exploration of the practical skills of newly qualified nurses in Nigeria can

also be researched.

- Study on approaches to nursing skills training in Nigeria can be done.

- Longitudinal study using more number of schools on the same topic is

encouraged for a better generalization.

140

Summary

This study assessed the factors affecting clinical training of nursing

students in School of Nursing, Afikpo and Department of Nursing Sciences,

University of Nigeria, Enugu Campus. It was designed to determine the:

- Administrative factors that could affect the clinical training of nursing

students in the schools and in the clinical areas.

- Training/Supervisory factors that could affect the clinical training of

nursing students in the schools and in the clinical areas.

- Students’ factors that may affect clinical training in nursing institutions.

- Whether there are significant statistical differences in the factors affecting

clinical training of nursing students between the two nursing institutions of

study.

Literature was reviewed according to the objectives of the study. The

research design used was a descriptive cross-sectional survey design. 311

respondents (teachers and students) were recruited for the study. A validated

questionnaire constructed by the researcher was used for the collection of data.

Data derived from the study was subjected to descriptive statistics and Z- test

for inferential statistics. Major findings of the study were: teachers were not

enough to handle the courses in school (A), mean score 2.75, teachers do not

supervise students in the clinical areas in both schools mean scores < 3.0 which

is below the mean decision point and both schools have only one or two

clinical instructors that supervise students during their clinical experience.

141

Both schools have practical laboratories but school (B) does not have enough

equipment and space in the practical laboratory, (mean scores = 2.69 & 2.65)

while school (A) has enough equipment in the school, (mean score 4.25) but do

not have enough equipment in the wards (mean score 2.32). Their supervisors

do not evaluate students during clinical period. Students attend clinical

experiences regularly and attempt clinical assignments/texts given to them,

(mean scores, school (A) = 3.33 & 3.33; school (B) = 4.86 & 3.97). Findings

revealed that there were significant statistical differences (p-value < 0.05)

between the two nursing institutions as regards the administrative,

training/supervisory and students’ factors affecting clinical training of nursing

students. Based on the findings, it was recommended that adequate

experienced and qualified nurse educators and clinical instructors should be

employed and maintained by the competent authorities. Proper supervision of

students should be advocated. N&MCN to provide a clearly written standard

guidelines and polices on clinical training of nursing students.

Conclusion

The study was to determine the factors that affect clinical training of

nursing students in School of Nursing Afikpo in Ebonyi State and Department

of Nursing Sciences, University of Nigeria, Enugu Campus in Enugu State.

Three research questions and three null hypotheses were formulated to guide

the study. The result of the findings showed that there were administrative,

training/supervisory and students’ factors that can adversely affect clinical

training of nursing students in both nursing institutions.

142

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148

APPENDIX (1)

Target population of academic staff and students from both nursing

institutions of study

NURSING INSTITUTIONS STUDENTS ACADEMIC

STAFF

YR 2 YR3 YR4 YR5

School of Nursing, M.M.H.

Afikpo, Ebonyi state.(School A)

Department of Nursing Sciences

UNEC, Enugu State.(School B)

53

42

94 107

14

20

Total 95 201 34

Source: Records department of the institutions

Total students = 296

Total Academic Staff = 34

Total target population = 330 subjects

149

APPENDIX (2)

Stages of skill acquisitions

Expert stage

Proficient stage

Competent stage

Advanced beginners

Novice’s stage

Fig. 1: Dreyfus’s model of skill acquisition

Source: Benner P. (2004), Judgment in nursing practice and education.

Bulletin of Science Technology and Society, 24 (3): 188- 190.

150

APPENDIX (3)

QUESTIONNAIRE ON FACTORS AFFECTING CLINICAL

TRAINING OF NURSING STUDENTS (QFACTNS)

I am a post graduate student of the department of Nursing Sciences,

University of Nigeria, Enugu Campus and I am carrying out a study on factors

affecting clinical training of nursing students in selected educational

nursing institutions in Ebonyi and Enugu states. A questionnaire will be

issued to each respondent for this study. There are no correct answers to the

questions. Your honest opinion to each question will help me to establish the

training needs of student nurses.

All the information you give will be held confidential and will be used

purely for academic purpose. Your sincere opinion on each question will be

highly appreciated.

Thanks for your anticipated co-operation.

AGU Grace U. (Rev. Sr.)

Department of Nursing sciences

Faculty of Health Sciences &Technology

College of Medicine, University of Nigeria

Enugu Campus.

151

APPENDIX (3) continued

QUESTIONNAIRE ON FACTORS AFFECTING CLINICAL

TRAINING OF NURSING STUDENTS (QFACTNS)

FOR BOTH TEACHERS AND STUDENTS

Please observe the following:

a. Tick only the correct answers to all the questions in sections A-D

b. Tick only the correct answers in the blank spaces provided.

SECTION A

Instruction: Tick the correct and the one related to you in the blank

spaces provided.

Name of Nursing Institute

a. School of Nursing, Afikpo

b. Department of Nursing, UNEC

Biodata

1. Gender: (a) Male (b) Female

2. Year of study: (a) year 2 (b) year 3

(c) year 4 (d) year 5

3. Designation: (a) Teacher (b) Student

4. Highest educational Qualification: (a) RN only

(b)B.Sc Nursing only (c) BSc. Anatomy only

(d) M.Sc. only (e) PhD

(f) Others indicate

152

5. Years of Teaching Experience

(a) 1 – 2 years (b) 3 – 5 years (c) 6 – 10 years

(d) 10 years & above

6. Teachers status: lecturer supervisor clinical instructor

SECTION B: Select the most appropriate answer to each statement from the

five (5) options of Strongly Agree (SA), Agree (A), Disagree (D), Strongly

Disagree (SD) and no opinion (NOP). Tick in the column of the item of

your choice.

SECTION B: Administrative factors:

Staffing:

7. The number of teachers in this school is:

< 4

4 -6

7-10

11 and above

8. Which of these act as clinical supervisors in your school?


Preceptors only

Nurses working in the clinical areas only

Students are not supervised

Both clinical instructors and staff nurses

9. If you are supervised in the wards, how many of the following

staff do supervise the students during each shift in the wards?

Tick the no. 1 2 3 4 5 6 and above


Preceptors only

Staff nurses in the wards or clinical areas only

√

153

ADMINISTRATIVE FACTOR (STAFFING) CONTD RESPONSES OPTIONS

ITEMS SA A D SD NOP

10. Teachers in this school are enough to handle the

subjects in the school.

11. Teachers in this school are involved in supervision of

students in the clinical areas.

Infrastructures/equipment:

12. This school has practical demonstration

laboratory for students clinical practice.

13. The laboratory has a large space for all the

students to observe what is being thought.

14. The school laboratory has enough equipment

that can enable many students to practice

procedures during the same period.

15. The hospital has enough needed equipment for

the number of students on each shift to practice with

while on clinical experience.

16. Students/ clients ratio in each ward during

clinical periods is enough for students’ practice

under supervision.

17. The school has a library with current nursing text


18. Teachers and students make use of the library.

Measures used for clinical training of students.

The school authority does the following to ensure

that students acquire the required nursing skills:

19. Organize clinical conferences/ seminars

for the students.

20. Encourage students to participate in

planning of their clinical training programmes .

21. Provide mentors and preceptors in each shift to

coach the students on the nursing skills.

22. Give students assignments during clinical

periods at least once a week.

23. Teachers do finish teaching their courses and

clinical procedures before students go to the clinical

areas.

154

Measures used for clinical training of students RESPONSE

OPTIONS

SA A D SD NOP

24. Students do repeat demonstration after

teacher’s own teaching during each procedure.

25. Clinical orientation are given to

the students at the beginning of each

clinical posting.

26. The ward staff nurses follow the correct

procedures in carrying out their job to enable

students to learn and do the right thing.

27. The ward staff nurses do supervise the

students during each procedure.

28. Supervisors do evaluate students’ clinical

experiences at the end of each clinical period.

29. The school Provide field trips/excursions, as

varied teaching and Learning opportunities.

Students’ factors towards clinical training

30. Every student attends clinical

experiences regularly as scheduled.

31. Every student attempts the clinical

assignments/tests given to them.

32. The students make use of the equipment in

the school laboratory for clinical practice

on their own.

33. Students do the following during

clinical experience:

- Self assessment of their clinical

performance,

- Accept corrections and ask their ward

staff questions during clinical experience.

34 Students use the nursing care procedure

book during clinical experience as a guide

for practice.

155

APPENDIX (4)

CALCULATION OF RELIABILITY OF QUESTIONNAIRE

(QFACTNS)

ITEM

NO.

TEST

X

RE-TEST

Y

XY

X^2

Y^2

1 23 23 529 529 529

2 20 18 360 400 324

3 24 24 576 576 576

4 10 5 50 100 25

5 20 20 400 400 400

6 4 4 16 16 16

7 8 10 80 64 100

8 3 3 9 9 9

9 0 3 0 0 9

10 21 21 441 441 441

11 23 23 529 529 529

12 24 24 576 576 576

13 16 16 256 256 256

14 23 23 529 529 529

15 22 22 484 484 484

16 19 19 361 361 361

17 20 15 300 400 225

18 15 20 300 225 400

19 20 22 440 400 484

20 22 20 440 484 400

21 22 21 462 484 441

22 18 18 324 324 324

23 0 2 0 0 4

24 25 21 525 625 441

25 13 13 169 169 169

26 23 23 529 529 529

27 22 22 484 484 484

28 20 20 400 400 400

29 22 22 484 484 484

SUM 502 497 10053 10278 9949

156


PEARSON CORRELATION COEFFICIENT ® FOR

QUESTIONNAIRE

(QFACTNS)

n = 29 ΣX = 502 ΣY = 497 ΣXY = 10053

ΣX2 = 10278 ΣY

2 = 9949

( ) ( )

( ) ( )

× −=

× − × −

2 2

29 10053 502 497

29 10278 502 29 9949 497

r

= 0.962r (For questionnaire items)

Hoel, P. G. (2006), Introduction to Business Statistics, seventh edition. John

Wiley & Sons, Inc. USA

157


CORRELATIONS FOR RELIABILITY OF INSTRUMENT

Using Statistical package for social sciences (SPSS)

Correlationsa

Test Re-test

Test Pearson

Correlation

1.000 .962**

P-value .000

N 29.000 29

Re-test Pearson

Correlation

.962**

1.000

P-value .000

N 29 29.000

**. Correlation is significant at the 0.01 level

(2-tailed).

158

APPENDIX (5)

Department of Nursing

Faculty of Health Science and Technology

University of Nigeria

Enugu Campus.

10th October, 2012.

The Head of Department,

Nursing Sciences

FHST

UNEC

Ma,

APPLICATION FOR ADMINISTRATIVE

APPROVAL OF RESEARCH WORK

I, Agu Grace Uchechukwu, a post graduate student of the Department

of Nursing Science, University of Nigeria Enugu Campus with registration

number PG/MSC/07/46796, wish to carry out a study on factors affecting

clinical training of nursing students in selected educational nursing institutions

in Ebonyi and Enugu states. I wish to use the Department of Nursing Sciences,

University of Nigeria Enugu Campus. I humbly solicit for your permission to

undertake the above research in the mentioned school using the teachers and

students nurses. Attached is the ethical clearance giving to me by the Ethical

Committee of UNTH Itukku Ozalla. The result of the research will be treated

with confidentiality and for the purpose of this research only.

Thanks for your co-operation.

Yours faithfully,

Agu Grace Uche (Rev. Sr) PG/MSC/07/46796

0706691465

159

160

161

162

APPENDIX (9)


Faculty of Health Science & Technology

University of Nigeria, Enugu Campus

10th October, 2011.

The Hospital Administrator

Mater Misericordiae Hospital

Afikpo

Ebonyi State.

Sir,

APPLICATION FOR ADMINISTRATIVE APPROVAL OF

RESEARCH WORK

I, Agu Grace Uche, a post graduate student of the Department of

Nursing Science, University of Nigeria Enugu Campus with registration


clinical training of student nurses in selected educational nursing institutions in

Ebonyi and Enugu states. I wish to use School of Nursing, Mater Misericordiae

Hospital Afikpo of which you are the administrator. I humbly solicit for your

permission to undertake the above research in the mentioned school using the

teachers and the student nurses. The result of the research will be treated with

confidentiality and for the purpose of this research only. I promise to abide by

the ethics of the profession.


Yours faithfully,


07066914650

163

APPENDIX (10)


Faculty of Health Science and Technology

University of Nigeria

Enugu Campus

10th October, 2011.

The Principal

School of Nursing

Mater Misericordiae Hospital

Afikpo

Ebonyi State.

Sir,

APPLICATION FOR ADMINISTRATIVE APPROVAL OF

RESEARCH WORK

I, Agu Grace Uche, a post graduate student of the Department of

Nursing Science, University of Nigeria Enugu Campus with registration


clinical training of student nurses in selected educational nursing institutions in

Ebonyi and Enugu states. I wish to use School of Nursing, Mater Misericordiae

Hospital Afikpo which you are the principal. I humbly solicit for your

permission to undertake the above research in the mentioned school using the

teachers and students nurses. The result of the research will be treated with

confidentiality and for the purpose of this research only. I promise to abide by

the ethics of the profession.


Yours faithfully,


07066914650

164

APPENDIX (11)

Department of Nursing Sciences,

Faculty of Health Sciences and Technology,

University of Nigeria,

Enugu Campus.

10th September, 2012.

The Chairman,

Health Research Ethical Committee,

University of Nigeria Teaching Hospital,

Ituku-Ozalla.

Sir,

APPLICATION FOR ETHICAL CLEARANCE

I, Agu Grace U. am currently carrying out a research project in partial

fulfillment for M.Sc. programme in the Department of Nursing Sciences.

The topic of the research is “Factors Affecting Clinical Training of Nursing

Students”. The research project is under the supervision of Dr. Mrs. Anarado A.N.

in the Department of Nursing Sciences University of Nigeria Enugu Campus.

About 340 copies of questionnaire would be shared out for responses on the

Factors Affecting Clinical Training of Nursing Students. Informed consent would

be sought from these respondents and information obtained would be treated with

utmost confidentiality.

I hereby humbly apply for an approval to enable me proceed and

accomplish this project within the time frame, October, 2012.

Attached are the project proposal and the copy of the questionnaire and

respondent consent form. Thanks in anticipation for the quick response.

Yours faithfully,

Agu, Grace U. (Rev. Sr.) PG/MSC/07/46796

07066914650

165

166

167

168

APPENDIX (15)

Hypothesis one: There is no significant statistical difference in the

administrative factors affecting clinical nursing training.

Table 13: Z-test of significance of differences between the two institutions of study

with regard to the administrative factors affecting clinical nursing training

n = 311

Items Schools n weighted

X score

Std

deviation

Z-test

score

P-value Decision

Teachers here are enough to

handle the courses in the

school

(A)

(B)

Total

115

196

311

2.75

3.23

2.64

.475

.819

.747

-5.766 .000* reject

Teachers are involved in

supervision of students in

the clinical areas.

(A)

(B)

Total

115

196

311

2.57

2.68

2.64

.909

1.045

.997

-.968 0.334 reject


demonstration laboratory

for students clinical practice

(A)

(B)

Total

115

196

311

4.51

4.03

4.21

.502

.640

.636

6.930 .000* reject


space for all the students to

observe what is being

taught.

(A)

(B)

Total

115

196

311

4.27

2.65

3.25

.831

.719

1.092

18.120 .000* reject


enough equipment that can

enable many students to

practice procedures during

the same period.

(A)

(B)

Total

115

196

311

4.25

2.69

3.27

.590

.715

1.009

19.757 .000* reject



number of students on each

shift to practice with while

on clinical experience.

(A)

(B)

Total

115

196

311

2.32

2.98

2.74

.488

.709

.710

-8.805 .000* reject

Students / patients ratio in

each ward during clinical. (A)

(B)

Total

115

196

311

2.09

3.35

2.88

.388

.896

.967

-14.359 .000* reject




(A)

(B)

Total

115

196

311

4.48

3.29

3.73

.820

1.038

1.121

10.540 .000* reject


the library

(A)

(B)

Total

115

196

311

2.10

3.63

3.07

.334

.975

1.089

-16.241 .000* reject

Level of significance = P<<<<0.05

NOTE: ∗∗∗∗ indicates significance difference at P<<<<0.05

Z- Score >>>> P- value (critical value) = reject the hypothesis

169

APPENDIX (16)

Hypothesis two:

Table 14: Z-test of significance of differences between the two institutions of study with

regard to training/supervisory factors affecting clinical nursing training

n = 311

Items Schools N weighted

X score

Std

deviation

Z- test

score

P-value Decision


following:

-organize clinical conferences/

seminars for the students

(A)

(B)

Total

115

196

311

3.03

3.59

3.38

.737

.821

.834

-5.940 .000* reject

-Encourage students to

participate in planning of their

clinical training programmes

(A)

(B)

Total

115

196

311

2.78

3.01

2.92

.526

.942

.819

-2.328 .021* reject

-Provide mentors and

preceptors in each shift to coach

the students on the nursing

skills.

(A)

(B)

Total

115

196

311

2.11

2.54

2.38

.345

.850

.734

-5.092 .000* reject

-Give students assignments

during clinical periods at least

once a week.

(A)

(B)

Total

115

196

311

2.56

2.91

2.78

.840

.821

.845

-3.667 .000* reject

Teachers do finish teaching

their courses and clinical

procedures before students go to

the clinical areas.

(A)

(B)

Total

115

196

311

2.10

2.47

2.34

.383

.838

.726

-4.469 .000* reject

Students are allowed to

demonstrate after teachers’ own

teaching during each procedure.

(A)

(B)

Total

115

196

311

4.69

4.06

4.29

.568

.898

.847

6.723 .000* reject

Clinical orientations are given

to the students at the beginning

of each clinical posting.

(A)

(B)

Total

115

196

311

2.58

4.03

3.49

.649

.705

.977

-17.942 .000* reject


correct Procedures in carrying

out their job to enable students

to learn and do the right thing.

(A)

(B)

Total

115

196

311

2.89

3.20

3.08

.632

.820

.770

-3.512 .001* reject

The ward staff nurses do

supervise the students during

each procedure.

(A)

(B)

Total

115

196

311

3.07

3.22

3.16

.758

.770

.768

-1.666 .097 reject

Supervisors do evaluate

students’ clinical experiences at

the end of each clinical period.

(A)

(B)

Total

115

196

311

2.57

3.03

2.86

.547

.952

.853

-4.653 .000* reject

The school provides field trips/

excursions as varied teaching

and learning aid.

(A)

(B)

Total

115

196

311

3.75

3.64

3.68

.660

.909

.826

1.082 .280 reject



170

APPENDIX (17)

Hypothesis three:

Table 15: Z- test of significance of differences between the two institutions of

study with regard to students’ factors affecting clinical nursing training

n = 311

Items Schools n weighted

X score

Std

deviation

Z-test

score

P-value Decision

Every student goes for

his/her clinical experiences


(A)

(B)

Total

115

196

311

4.74

3.42

3.91

.677

.677

15.832 .000* reject

Every student attempts the

clinical assignments / tests

given to them.

(A)

(B)

Total

115

196

311

3.92

3.83

3.86

.791

.728

.754

1.017 .310 reject

Students make use of the

equipment in the school

laboratory for clinical

practice on their own.

(A)

(B)

Total

115

196

311

3.15

2.51

2.75

.596

.829

.829

7.045 .000* reject

Students do the following

during their clinical

experience:



(A)

(B)

Total

115

196

311

3.04

2.71

2.84

.536

1.155

.985

2.879 .004* reject

Accept corrections and ask

ward staff questions. (A)

(B)

Total

115

196

311

4.61

4.24

4.38

.684

1.203

1.05

2.927 .003* reject

Students use the nursing

care procedure book during

clinical experience as a

guide for practice.

(A)

(B)

Total

115

196

311

4.16

3.72

3.88

.643

1.021

.923

4.084 .000* reject

Level of significance = P<<<<0.05



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BY AGU GRACE UCHECHUKWU PG/MSC/07/46796 M.SC … MAIN PROJECT DISSERTATI… · AGU GRACE UCHECHUKWU PG/MSC/07/46796 M.SC DISSERTATION ... (Staffing) affecting Clinical Training of